The Obama administration’s decision this week to delay implementation of the health insurance mandate for businesses with 50 or more employees is no small matter. In fact, removing the mandate could lead to the unraveling of the entire law — if not in actual public policy terms, at least in public opinion.
I have a confession to make. Four years ago, when I was making my first arguments against the looming threat of the new administration’s health care reform plans, several of my blue-collar-worker patients with poor or no health insurance told me they were happy about the potential law because they thought it meant they would be covered and would be able to see a physician free of worry.
Four years later, these same patients are not happy. They are not bragging about the new law. They are not saying, “I told you so.”
What they are doing instead is complaining their premiums have risen too high, or that the coverage they anticipate getting looks too complex , or that they expect to lose their employer-based health insurance at any time and be made a part-time employee. Many are worried they will no longer be able to afford the plans their bosses are offering and fear being compelled to seek coverage on the state exchanges, where the policies could be impossible to afford.
As a practicing doctor, I would be inclined to raise a bigger stink about all this, and I know many of my colleagues would join me, but we are too overwhelmed with paperwork, regulations and the growing dysfunctional features of health insurance to engage in a concerted protest.
Before this week, the idea of an employer mandate — requiring companies to provide health insurance for their employees in 2014 or face a stiff fine of up to $3,000 per employee — was a small consolation. It meant that businesses would share the burden with individual families.
Now that it has been delayed at least a year, my patients’ fears of being uncovered and losing access to good health care are sure to grow.
How will delaying implementation of the mandate on large and medium-sized employers affect the function of this massive, complex, interconnected new piece of public policy machinery? We can make a very educated guess.
Without the mandate as a disincentive, I expect employers to be more inclined than ever to dump their employees’ coverage, sending people in droves to the state exchanges. Once there, they will be faced with the individual mandate and a health insurance policy they may not be able to afford.
The delay in the mandate on businesses will also cost the federal government. The government will kiss goodbye the $5 billion a year it was expecting to raise from these penalties, even as it has to pick up the bill for employees who lose their coverage as a result of the delay and end up with subsidized coverage on the exchange.
No wonder many of my patients are very upset at this latest Obamacare inconsistency. Starting in 2014, they will still face a penalty for not buying insurance while their employer won’t.
There is a growing consensus in my office among patients who were once looking forward to the law passing: Obamacare is too expensive, too complex to work, and, worst of all, it doesn’t guarantee you access to good doctors or good health care.
A recent nonscientific survey of 13,000 doctors by the Physicians Foundation showed that most of us now feel negative about our work. A survey of more than 600 physicians by Deloitte revealed that most of us would consider quitting or retiring early as a result of Obamacare.
Why? More than half our time is spent doing paperwork, while trying to work with Obamacare’s shifting insurance plans. Growing regulations bury both doctor and patient in an impersonal interaction.
This is not what any of my patients had in mind when Obamacare was under development.
Siegel, M.D., is an associate professor at New York University School of Medicine.
Read more: http://www.nydailynews.com/opinion/health-care-reform-great-unraveling-article-1.1389711#ixzz2YH3gMvO7
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