So, how are we doing complying with the PPACA (Patient Protection and Affordable Care Act) also known fondly as Obamacare? Let's review some of the features and how they're working.
Well, two features that were widely accepted were the provisions related to pre-existing conditions and children coverage to age 26. The only groups not pleased with this were the health insurance companies. Polls indicate that people and employers generally had no negative opinions on these issues.
And that, my friends, is where favorability ends.
Since passage by the Congress and signature by President Obama, this law has been under attack from various groups including, state attorneys general, employers, unions and religious groups, including faith-based employers and not surprisingly, the Catholic Church.
The church and faith-based employers don't like the law because as self-insured employers, the law requires that they offer services to their employees which are contrary to the beliefs of those organizations. These include primarily birth control and abortion, which certainly are in opposition to the church's practices. In response to the pending lawsuit by the church, HHS has issued a waiver until 2015 for the church to comply, but the church continues its lawsuit.
Unions are disgruntled because waivers issued to them at the time of the law's enactment are expiring and will not be renewed. This is especially an issue because unions were among the biggest proponents of the legislation and leadership feels they were used to get the law passed. Really? What s surprise!
On June 27, 2012 the Supreme Court, by a 5-4 vote, ruled against the various states' attorneys general in their suit concerning a violation of the Constitution's commerce clause and ruled instead that it wasn't a fee to be applied for non-compliance but rather a tax, which was certainly in the purview of the Congress to assess. This ruling made the claim by the President and the bill's supporters that no new taxes would be assessed invalid.
Employers, in order to keep their costs for health care to a minimum or nonexistent, are working to keep their full-time workforce at 49 full-time employees. The law says that if a company has 50 or more full timers, then the employer must cover everyone or pay a substantial fine for noncompliance. In actuality, the fine is generally less than the employer cost of an employee's health care.
Finally, by October 1, states are supposed to have health exchanges set up for those not covered by a health care plan to go to enroll for coverage to be effective on January 1, 2014. Today is May 2 and many states have not yet begun the process to create the exchanges, and therefore, the government has to either set up the exchanges itself, which would cost the federal government millions, if not billions, to do in such a short time, or have HHS grant a waiver to itself to set up the exchanges by October, 2015.
Members of Congress are now voicing concern that Obamacare will effect them in the 2014 mid-term elections, especially those Democrats who were vociferously for it back in 2010. In fact, Senator Max Baucus, Democrat from Montana, who was one of the creators of President Obama's signature piece of legislation, called it a "train-wreck" in his announcement that he would not seek another term next year.
Democrats generally, who are up for re-election, are calling for various changes to the law before next year. The Republicans have their best chance in that election to continue control of the House of Representatives and regain control of the Senate. Should that happen, any piece of President Obama's agenda as outlined in his second Inaugural Address and this year's State of the Union address will probably die in committees. And his legacy will be doomed.
And his signature piece of legislation will be the cause of his downfall.
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