Is Obamacare turning the corner?

The Washington Post

By Ezra Klein and Evan Soltas, November 26, 2013

Welcome to Wonkbook, Ezra Klein and Evan Soltas's morning policy news primer. To subscribe by e-mail, click here. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

A spin through HealthCare.Gov this morning went smoothly. The site loaded quickly. The process progressed easily. There were no error messages or endless hangs. I didn't complete the final step of purchasing insurance but, until then, the site worked -- or at least appeared to work -- exactly as intended.

My experience isn't rare. There are increasing reports that HealthCare.Gov is working better -- perhaps much better -- for consumers than it was a few short weeks ago. "Consumer advocates say it is becoming easier for people to sign up for coverage," report Sandhya Somashekhar and Amy Goldstein in the Washington Post. "The truth is, the system is getting stronger as it recovers from its disastrous launch," writes Sam Baker in the National Journal. Applying "was no problem at all, with no delays," says Paul Krugman.

Reports from inside the health care bureaucracy are also turning towards optimism. People who knew the Web site was going to be a mess on Oct. 1st are, for the first time, beginning to think HealthCare.Gov might work. Data backs them up: By mid-November, the pace of enrollment in the federal exchanges had doubled from what it was in October.

The Obama administration is certainly acting like they believe the site has turned the corner. Somashekhar and Goldstein report that they're "moving on to the outreach phase, which had taken a back seat as they grappled with the faulty Web site. Next week, the White House will host an insurance-oriented 'youth summit' aimed at people ages 18 to 35, an age group whose participation in the health-care law will be critical to its success."

The White House had held off on this kind of outreach because they believed it would simply drive people to a useless Web site. If they're restarting the outreach, it's because they believe, rightly or wrongly, that HealthCare.Gov will be able to convert the interest into enrollments.

The worry, at this point, is that the site is working in ways that are visible but broken in ways that are harder to see. The Obama administration won't answer direct questions on the percentage of "834s" -- the forms insurers need to sign people up for the correct policies at the correct prices -- that are coming through with errors. Robert Laszewski, a health-industry consultant with deep contacts among the insurers, told the National Journal the problem is getting better, but that his clients are still seeing a five percent error rate. That's still too high.

The systems that determine whether applicants are eligible for insurance are also improving. But inside the administration there's a recognition that it was error-ridden in the first six weeks of Obamacare -- and so the question is how to handle the many people who unknowingly received an eligibility determination that can't be trusted.

Still, it's clear that HealthCare.Gov is improving -- and, at this point, it's improving reasonably quickly. It won't work perfectly by the end of November but it might well work tolerably early in December. A political system that's become overwhelmingly oriented towards pessimism on Obamacare will have to adjust as the system's technological infrastructure improves.

The next challenge for the law, as the White House knows, will be the outreach challenge of signing up enough young-and-healthy people to balance out its risk pools. That's a challenge the White House spent quite a lot of time thinking about before this IT nightmare. The question is whether they still have enough time, and enough clout, to get it right.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/26/wonkbook-is-obamacare-turning-the-corner/?print=1

This chart is amazing news for our health cost problem

The Washington Post
By Sarah Kliff, Published: November 20 at 3:55 pm

This just might be my favorite chart about health care costs as of late. And it's one that contains billions of dollars' worth of good news!

The chart, from the Council of Economic Advisers, shows the Congressional Budget Office constantly revising downward how much it thinks the federal government will need to spend on health care costs over the next decade. That's because health care costs have been growing a lot more slowly over the past few years than they typically do. You can see that below, with a breakdown of health care cost growth by source of coverage.

In private insurance, the average spending growth rate per person has slowed a lot over the last few years. In Medicare, there was no spending growth between 2010 and 2013 and, in Medicaid, per person costs actually decreased some.

All told, health care costs have been growing more slowly over the last three years than any other time period since 1965. More recently, yearly health cost growth slowed from an average rate of 3.9 percent between 2000 and 2007 to 1.3 percent between 2011 and 2013.

The big health policy parlor game for the past few years has been to ask: How much of this change is cyclical, owing to the recession, or structural, partially due to the health law's payment reforms?

The White House has long argued that the changes are structural, and it made that case again Wednesday in a briefing with reporters.

"The slowdown is indisputable," Council of Economics Advisers chairman Jason Furman said. "A very important part of that is structure, and a very important part of the structural story is the Affordable Care Act."

Most health care economists now agree, at least to some extent, with this more structural view.  Even those who argue that the current slowdown is unlikely to last, such as Harvard's Amitabh Chandra and Dartmouth's Jonathan Skinner, still expect slower health care cost growth in the next decade compared with the previous one.

And in some cases, that translates into better health care, too. This chart from the council's report shows a significant drop in preventable readmissions to hospitals (when  treatment goes wrong the first time and the patient must return to the hospital). That happened right around the time Medicare began penalizing such return trips to the hospitals.

Cost savings aside, that's great news for patients, suggesting that the quality of care hospitals are delivering is improving at the same time that spending on that care is slowing down.

Original Article

Under Health Care Act, Millions Eligible for Free Policies

The New York Times
November 4, 2013

By REED ABELSON and KATIE THOMAS

 

Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs.

Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.

The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.

Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.

The latest analysis was conducted by McKinsey’s Center for U.S. Health System Reform, whose independent research has been cited by the federal government and others.

“The whole point of the law was not only to cover the uninsured, but so people didn’t have to make choices between food or drugs, or going to the doctor or dentist,” said Karen Davis, a health policy expert at the Johns Hopkins Bloomberg School of Public Health. “It’s what it is designed to do.”

Many insurers tried to price their least expensive plans so they would become free or nearly free with the addition of subsidies that are set based on a person’s income and the cost of a midlevel, or silver, plan.

Independence Blue Cross in Philadelphia has four plans that are free to some customers. But the company, along with other insurers, has been careful not to publicize its free coverage for fear of alienating customers who will need to pay more.

“We’re not advertising zero dollar,” said Brian Lobley, a senior vice president at Independence Blue Cross. But the company is promoting monthly premiums in the $20 to $30 range, he said.

The Obama administration has also stressed affordability over coverage with no monthly charge, frequently saying that the cost of coverage will be less than a monthly cellphone bill for many consumers. Officials at the Department of Health and Human Services would not comment on the McKinsey analysis, saying in a statement that the goal of the health law was to provide a range of options for people with differing needs and budgets.

The analysis found that five million to six million people who are uninsured will qualify for subsidies that will be greater than the cost of the cheapest bronze or silver plan. A million more people with individual insurance could also be eligible, according to McKinsey, although estimates of the size of the market for private individual insurance vary widely. None of the people in the analysis qualify for Medicaid.

The availability of zero-premium plans may make the deal especially enticing to the healthy young people the marketplace needs to succeed, said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School. “This is such a good deal that you’d have to believe you were immortal not to really pick it up,” he said.

Although they vary in their design, bronze plans generally cover about 60 percent of a person’s medical costs. All plans, including bronze, must cover standard benefits like prescription drugs, maternity care and mental health treatment.

The availability of the zero-premium plans varies across the country. McKinsey found that about 40 percent of the uninsured in Missouri will be able to select a no-cost bronze plan, for example, compared with 2 percent of the uninsured in New Jersey.

Its estimate, based on an analysis of premiums for plans offered in the marketplaces in all 50 states and the District of Columbia, is in line with two other estimates, by Credit Suisse and Morgan Stanley.

The McKinsey researchers also found that about half of the people eligible for zero-premium plans were under 39 and uninsured. The Obama administration has been emphasizing the affordability of its plans for young people, a critical group because their participation in the marketplaces will help keep overall premiums low.

It is impossible to know who will actually sign up, and whether they will choose a zero-premium plan.

For many people, paying slightly more for a silver plan may be a much better option, experts said. Ninety percent of those who will have the option of buying the no-cost plans make less than 250 percent of the federal poverty level, which is $28,725 for an individual, and $58,875 for a family of four. People earning below those thresholds are eligible for the most generous assistance, but only if they choose a silver plan.

About a million of those who will qualify for free coverage will be able to buy a silver plan for no monthly cost. McKinsey, which is releasing a report about the new insurance marketplaces, estimates that the cost of silver plans for the people who qualify for a zero-premium bronze plan will range from $40 to $50 a month.

“They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute.

All plans, including bronze policies, limit annual out-of-pocket costs to $6,350 for individuals and $12,700 for families. But insurers and advocates said out-of-pocket costs — even those under that limit — can be daunting to people with low incomes.

For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of signing up for a bronze plan were outweighed by the prospect of getting it free. The Horsts, who make $24,000 a year between them, qualified for $612 in monthly subsidies, but the cost of a bronze plan was $581 a month.

“We’re in good health,” Mr. Horst said.

Besides, he said, they can always switch to a better plan next year. “At this point, it’s a little bit of a gamble.”

Not everyone selects the cheapest option. Dante Olivia Smith, a lighting designer from Manhattan, learned that federal subsidies would allow her to buy a bronze plan for $24 a month.

“It was astounding,” she said. “I almost started crying, and called my mom.”

In the end, however, she went with a silver plan for $91 a month that included dental and vision coverage. Ms. Smith, who is 30, said she opted for the more comprehensive plan because of her work, which requires her to climb ladders and use power tools.

“If I had a different job, for 24 dollars a month I would have been like ‘Woo-hoo!' ” she said. “But the reality is, I know what my risks are in my life.”

http://www.nytimes.com/2013/11/04/business/under-health-care-act-millions-eligible-for-free-policies.html?adxnnl=1&pagewanted=all&adxnnlx=1383664168-KWv3q73RZKdGIjFlNug2Zg

Small Business Forum on Health Insurance

This Thursday the City of Columbia will be holding an open forum on the impact of the Affordable Care Act on small businesses.  I will be moderating the panel presentations and discussions.  Another forum will be held October 23rd.


Registration is free: https://columbiaaffordablecareactforum.eventbrite.com

This is a great opportunity to learn how small businesses can effectively use the Health Insurance Marketplace (when it is fully functional) to not only make sure that employees have affordable health insurance that best fits their needs but also possibly how a small business can compete with companies that offer health insurance to employees without directly offering the employee benefit.  Small business owners might also find other options that could actually increase their bottom line.

 

 

Affordable Care Act Forum:

The Impact on Small Businesses

This forum will offer details and solutions on the Affordable Care Act for small businesses. The forum will feature a panel of experts from the insurance, legal and accounting industries who will help attendees understand the requirements, opportunities and benefits of the Affordable Care Act. Panelists will discuss:

 What does the Affordable Care Act do and not do for small businesses?

 What will be the impacts on small businesses in South Carolina?

 How can small business owners save more money?

 What are the opportunities for small businesses in South Carolina?

Session I

Thursday, October 17

9-11 a.m.

Columbia Metropolitan Convention Center 1101 Lincoln St.

Register by Tuesday, October 15

 

Session II

Wednesday, October 23

6-8 p.m.

Earlewood Community Center

1111 Parkside Dr.

Register by: Monday, October 21

Registration is free: https://columbiaaffordablecareactforum.eventbrite.com

For more information, contact Angelo McBride at 803.545.3960 or email aamcbride@columbiasc.net.

Health insurance industry targets Charleston's hospitality workers during Obamacare launch

Charleston City Paper
October 9, 2013

by Corey Hutchins @coreyhutchins

Nick Johnson is a 33-year-old Folly Beach bartender who hasn't had health insurance since he was 18. He also hasn't seen the inside of a hospital or a doctor's office for more than a decade, but two weeks ago he injured his left hand playing baseball with his nephew. It still hurts in the mornings, but he says he can deal with it.

Last week, the Affordable Care Act's online health insurance marketplaces opened for the first time, giving those without insurance the opportunity to buy it at, hopefully, reduced rates. In fact, some individuals can even receive government-subsidized coverage if they meet certain income levels. But Johnson is uncertain how much he'd be willing to pay for good coverage even if he did shop around. For the Folly Beach bartender, getting health insurance isn't a big concern.

And like many his age, Johnson doesn't have any idea what he'd do if he suffered a major accident and hospital bills started piling up. "I've never thought about it because I've never needed it," he says. "It just doesn't seem worth it to me."

Frank Knapp, president of the S.C. Small Business Chamber of Commerce and an advocate for the new healthcare law, says there's no reason a 33-year-old single male bartender shouldn't take responsibility for his own healthcare. As for those who are 30 and younger, the ACA offers low-cost catastrophic health care plans that cover major accidents but offer high deductibles, a good deal for those Knapp calls "young invincibles" who rarely go to the doctor. "I've heard some reports of these plans being almost free," Knapp adds.

The food and beverage industry is full of the kind of uninsured healthy young people the government hopes will sign up through the new exchanges. After all, the more people paying for coverage who aren't using it, the better the system is.

Here in South Carolina, state GOP leaders chose not to create state health care exchanges, so the federal government is operating them instead. While there are groups that are designed to help people navigate the process of getting signed up — like those who received federal Navigator grants — they can't reach everybody. And when it comes to Navigators, they can't recommend a healthcare plan, but they can show you your options. Licensed brokers, however, can do both.

One of them is Clark "Corky" Ullom, president of the Georgia-based HIX Marketplace who works for a private company licensed in 48 states to help people figure out the process of getting covered. Last Wednesday, he was stationed outside a giant Health Aviator tour bus parked in Marion Square as young guys tossed around frisbees and girls in bikinis sunbathed nearby. The insurance companies that are on the exchanges pay Ullom and his company for each individual they sign up. The Health Aviator bus will be in Charleston for the next three weeks, and Ullom says they've zeroed in on one specific industry.

"Hospitality is our main focus," he says from behind a pair of sunglasses.

His company has already partnered with the Greater Charleston Restaurant Association, and thousands of his business cards will end up in the envelopes of Lowcountry service industry workers when they get their next paycheck.

"You've got hard-working young people who don't have an opportunity for any type of reasonably priced health insurance," he says. "It's the biggest market out there." He also notes that a lot of these uninsured workers are confused about the recent government rollout and are looking for people like him to help them sign up.

One such worker is a local bartender and recent College of Charleston graduate named Charlotte Woodward. Most of what the 22-year-old has heard about the exchanges has centered around the right-wing/left-wing talking points. "I don't know much about the details," she says.

While she was in college, Woodward had cut-rate coverage that was rolled into her tuition, and she says it wasn't great. But now she's uninsured. Since she's under 26, she could technically be on her parents' plan, but she says that isn't an option.

Right now, Woodward's plan is to pursue another job outside the hospitality industry that will offer her an affordable and solid health plan. "I've done OK without it this far, but there have been some things health-wise I've been putting off and that's never good," she says.

Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center and a supporter of the federal healthcare law, hopes Woodward gets covered. "I want the people bringing food to my table to be healthy," she says. "It's worth it to start thinking about how you care for your health and well-being and look at that as part of your expenses."

Berkowitz says Woodward should visit healthcare.gov and see if she's eligible for a subsidy. Berkowitz says the bartender could probably get an affordable plan that offers coverage and preventative care, including screenings and physicals, with co-pays as low as $30 or $20 for a visit. Prescriptions like birth control would be covered with a similarly-priced co-pay, the Appleseed director adds.

Berkowitz blames the state's Republican leaders for why many young people are largely unaware of the ACA. South Carolina is one of the states choosing not to expand Medicaid, and Republican lawmakers had opposed implementation of the law. In fact, a failed bill in the state Senate would have made it a crime for public officials to implement the law here. More recently, Republican Gov. Nikki Haley told the media the state was doing all it could to help people sign up, but pointed out that the healthcare.gov website hasn't been working for everybody. "We're going to continue doing what we can," Haley said, "but this is continuing to be the mess we thought it would be."

Problems with the federal website underscore something of a disconnect. Yes, there may be so many people clamoring for healthcare that the website is overwhelmed, but there are plenty of uninsured people with no clue that it even exists.

Consider Matt Vliet, a 26-year-old uninsured student in a welding program at Trident Technical College who works at night as an independent contractor for a local pedicab company. He's isn't sure how the ACA might affect him. When he was told about the healthcare.gov site and what it does, Vliet says he'd be willing to check it out, but he is also willing to go without coverage for the time being. He hopes he'll get a good job with a decent health plan after he graduates.

Vliet is clear about one thing. He knows he will be fined if he doesn't get coverage. After 2014, most Americans without coverage will have to pay $95 or 1 percent of their income (whichever is higher) when they pay their taxes if they don't have health insurance. That fine will go up the following year and could be as much as $695 by 2016. The Congressional Budget Office estimates the federal government could net some $7 billion from the roughly six million people who could end up paying fines. One of them might be Vliet.

"Just because of my age and my invincible nature, I probably would be willing to pay the fine instead of health insurance at this point in my life," he says while parked on King Street outside PURE Theater Wednesday night. "I think most people under 30 would be willing to pay the fine."

And it's that attitude that some anti-Obamacare groups are banking on. Actually, they're actively pushing such a message on college campuses. Virginia-based Generation Opportunity, for instance, is running an ad campaign called Opt Out. In one ad, a college-aged girl who signed up for Obamacare is led into a gynecologist's office and asked to put her feet in stirrups. After the nurse leaves, someone dressed in a creepy Uncle Sam costume rises from between her legs brandishing a speculum. "Don't let government play doctor," the onscreen text reads. "Opt out of Obamacare."

Part of the right-wing war on the new healthcare law could be an attempt to cripple its effectiveness, and people like Vliet are the ones caught in the middle.

Back on the King Street pedicab, Vliet thinks about some of his colleagues who have been hit by cars or injured on the job. He says if someone showed him how to shop around for coverage and he could get it really cheap, he might sign up. But even then he's doubtful he would purchase health insurance.

"I wouldn't be willing to pay $150 right now while I'm in school," he says.

http://www.charlestoncitypaper.com/charleston/health-insurance-industry-targets-charlestons-hospitality-workers-during-obamacare-launch/Content?oid=4772288

On October 1st use an insurance professional when shopping in the Marketplace

Five days until we are supposed to be able to shop in the new Health Insurance Marketplace.  While some states running their own Marketplaces might be having some difficulties in being ready, the Feds who are running the South Carolina Marketplace insist that on October 1^st the doors of the online site will be open for business.

Stories are coming out now about what South Carolinians will find when they start shopping (here and here).  If you are still confused after reading about what will take place, you aren’t alone. 

I strongly urge individuals and small business owners not to try go through this process without guidance.  In every premium of every policy on the Marketplace is a commission to pay to insurance agents and brokers.  If you don’t use these insurance professionals to help you in the Marketplace, your premiums still are the same.  So if you are already paying for professional help, use it.

One private South Carolina insurance broker that has received much attention as a good source of assistance in the Marketplace is HealthAviator.com (here and here).   Not only can insurance agents and brokers provide you with professional assistance at no cost to you in shopping and enrolling in the Marketplace, they also can do what no other facilitator can do….actually recommend the best plan for you.  Only licensed insurance agents and brokers are legally allowed to make such a recommendation.

But not all insurance agents and brokers are alike.  What you want is an agent or broker who is licensed with all four insurance companies in the Marketplace.  There are agents and brokers who art tied to a specific insurance company so they might be biased in their recommendations (i.e. they won’t make a commission if they don’t recommend a policy from their own insurance company).

So get yourself some unbiased professional assistance by getting an insurance agent/broker who is licensed with all the Marketplace carriers.  HealthAviator.com is certainly one that is putting a lot of emphasis on working to properly enroll people in the Marketplace with professional recommendations.  But there are others out there also. 

Bottom line…get professional insurance agent/broker assistance and really make the Health Insurance Marketplace work for you.

Here’s the deal—40 hours is full-time but only in Medicaid expanded states

The Hill's Congress Blog
September 24, 2013

By Frank Knapp Jr.  

Franchise owners descended on Capitol Hill last week to lobby for a modification in the Affordable Care Act.  Their complaint is that under ObamaCare, starting in 2015, businesses with 50 or more full-time employees will either have to offer their workers affordable health insurance or pay a penalty fee under the law’s shared responsibility mandate.

But there’s an easy solution that answers their concerns and at the same helps address one of the biggest threats to success for ObamaCare. 

While my business organization favored no mandate for businesses to offer health insurance -- or alternatively that businesses with fewer than 100 employees should be exempted under such a provision -- we did support the overall healthcare reform effort and ultimately the final version of ObamaCare. The health insurance affordability crisis demanded Congressional action. Plus, by exempting small businesses with fewer than 50 employees from the requirement of shared responsibility, approximately 96 percent of all businesses across the nation are under no obligation to offer health insurance to their employees.

Specifically what the members of the International Franchise Association (IFA) are asking Congress to do now is change the law so that only employees working at least 40 hours a week are counted toward that 50 full-time employee mark. The law now counts employees working at least 30 hours a week as full-time employees.

These business owners, primarily in hospitality and retail, say that they will cut the hours of their workers to stay under the present 30-hour per week rule.  The result, they say, would be employees making less money and still not receiving health insurance.

But that’s not completely true. These low-income workers with reduced hours almost assuredly would receive health insurance if their states expanded Medicaid as provide for under ObamaCare.

The primary purpose of the Affordable Care Act was to get affordable health insurance for almost every citizen. The shared responsibility mandate was simply a way to get the big business community to help with the cost.

Unfortunately, now the larger issue that threatens the success of the healthcare reform is the refusal of at least 21 states to expand Medicaid. Without this expansion almost five million of the mostly working, low-income people in these states will still be uninsured and continue to drive up the cost of health insurance for people with coverage due to cost-shifting. This “hidden tax” on every health insurance policy to pay for the uncompensated care for the uninsured adds about $1000 to every family policy per year according to the actuarial firm of Millikan, Inc.

A compromise is in order that will give these franchisees the relief they are looking for and address the Medicaid expansion problem.

Congress and the president should consider changing the definition of a full-time employee to at least 40 hours per week but only in states that expand Medicaid up to 133 percent of the federal poverty level.  Since logic and common sense were rejected by the states that refused to expand Medicaid, maybe pressure by the IFA business members will be more effective.  The result could be a win-win-win—businesses, low-income workers and insurance policyholders.

Knapp is the president of the South Carolina Small Business Chamber of Commerce and the co-chair of the American Sustainable Business Council Action Fund.

Read more: http://thehill.com/blogs/congress-blog/healthcare/324015-heres-the-deal40-hours-is-full-time-but-only-in-medicaid-expanded-states#ixzz2fpPES2Fd

All Employers: Important Health Care Reform Deadline

There is an very important deadline coming up on October 1, 2013, associated with the Affordable Care Act . 

EVERY BUSINESS WITH AT LEAST ONE EMPLOYEE MUST COMPLY.

Fortunately, complying is relatively easy and the forms below will get the job done. 

Simply put, you as the employer are providing important information to your employees about the new health insurance marketplace.

If you need help and want assistance in understanding this requirement or you need advice in how to answer employee questions or you want to know what all your options are under the new healthcare law, call David Harrell at (803) 586-7571.  There is no cost for this assistance and there is a good chance that you will find that one of these options will positively impact your bottom line and your employees.

By October 1, 2013...

All employers regardless of how many employees or if they offer an employer sponsored health plan must provide Notice of Exchanges and Subsidies (NOE) letters to all employees.  The Department of Labor has released two versions of these letters.  

The first is for employers who offer a sponsored health plan.
Offering Health Insurance

The second version is for those employers with no health plan.  

No Health Insurance

These forms can be distributed to your employees via hand, email or first class mail. 

Again, if you need any free advice in complying or have any questions about the coming-soon health insurance exchange, call David Harrell at (803) 586-7571.

Honest debate with Obamacare opponents not possible

Thanks to Jeff Wilkinson, reporter for The State, for his front page story yesterday on the impact of Obamacare on businesses.  As these now familiar pieces go you start with one business owner (usually as in this case a restaurateur with hundreds of employees) complaining about how the healthcare reform is forcing him to cut employee hours which makes it hard to recruit workers, stops him from expanding to meet demand, worries him about increased health insurance premiums, and creates uncertainty.

But unlike most of these almost scripted “the sky-is-falling” anti-Obamacare pieces, Wilkinson not only seeks out the countervailing opinion (and facts) but reports them in an effective informative story. 

He caught up with me while I was out of town late this past Friday afternoon.  Here was my part of the story:

But Frank Knapp, president and chief executive of the S.C. Small Business Chamber of Commerce, said that the hospitality industry is facing the most challenges from health care reform because they need so many employees, pay the least and have the highest turnover.

He noted that 96 percent of all businesses in the state have fewer than 50 employees and won’t be required to provide health insurance. And, he said, large manufacturing firms that provide health insurance have already positioned themselves to absorb any new costs. 

 “This has always been a tempest in a teapot,” Knapp said. “The opponents have always targeted that little sliver who, maybe in 2015, will be required to provide health insurance, or their premiums will go up.”

He added that those business owners with fewer than 50 employees could be better off with cheaper rates for themselves and healthier employees because they would have better access to health care.

“We are so close to a revolution in health care insurance,” he said. “People are going to be surprised.  There are going to be a lot of options for small business owners. It’s an exciting time.”

Very accurately reported except for the part about premiums going up.  I was probably talking too fast, as usual, for Wilkinson to understand that I was referring to penalty fees, not premiums, a larger employer might have to pay in 2015 if they do not offer affordable health insurance to their employees. 

 And as expected, I received a message from a business person who took exception to my comments in the story.  He wrote in his email:

I was interested to read the comments attributed to you in the The State today. You mention that 96% of employers won't be impacted anyway and that it is a "tempest in a teapot". I find that statistic entirely misleading since it equates employers, such as my firm (with a few employees), in the same manner as an employer with 40 employees. Each of us is counted as one employer. If you consider the number of employees impacted by ACA, it is sharply different than the percentage you quoted. A large number of employees work in multi-unit restaurant or retail businesses that are "large" for purposes of this law. If we are about to have a "revolution in health insurance", at least we should do it honestly

Well, I agree about the need for “honesty” in the debate.  Too bad that honesty has been absent from the opponents of the healthcare reform.  And unfortunately the comments from my critic appear to be just a continuation of the lack of honesty.

The gentlemen calls my use of the factual statistic that 96% of the state’s small businesses have fewer than 50 employees and thus won’t be required to offer health insurance a misleading statement.  The reason he says (and I am trying to understand his logic) is that I don’t take into account that his few-employee business is counted in that 96% the same as a 40-employee business.

Well, he and the 40-worker business owner are accurately included in the statistic I used since it refers to businesses with less than 50 workers.  Even better, Obamacare treats them the same by not requiring either to offer health insurance.  That’s a good thing and something the South Carolina Small Business Chamber lobbied Congress to include in the Act.  So I don’t understand the reader’s beef except that it was a poor segue to a new convoluted and dishonest argument. 

The reader attempts to say that the real issue is the total number of employees that work in larger businesses that will be required by Obamacare (again not until 2015) to either offer affordable health insurance or pay a penalty fee. 

This is a good example of how the opponents of Obamacare work their magic. 

For well over three years the rhetoric of the opposition has been about how bad Obamacare is going to be for small business owners.  But now that reality is hitting the deceived public right in the face with the fact that very few small businesses will be required to provide employee health insurance, the opponents must find a new twist to confuse the public.

Apparently, according to the anti-Obamacare crowd, it is now the total number of employees working for businesses with 50 or more employees that is the important statistic not the embarrassingly tiny percentage of small businesses that might be negatively impacted by the law.  The opponents know that healthcare reform supporters have nearly won the “small business” issue so they’re ready to dump that talking point and move onto another.

The Obamacare opposition doesn’t really want an “honest” debate.  They want to continue to mislead and fear monger.  But those tactics will no longer work in a few months when the health insurance exchanges open and small business owners find out the beneficial options they have for helping themselves and their employees under Obamacare.

If you want to know what those options will be, contact me at sbchamber@scsbc.org.