Follow the Yellow Brick Road to Health Care Law Facts

Dec 13, 2012

On television, Dr. Oz dishes out a lot of advice on medicine and staying healthy.  He should stick to what he’s good at and not wade into health care policy. In a column with Dr. Mike Roizen of the Cleveland Clinic Wellness Institute, he answers a reader’s question about the benefits of the health care law, the Patient Protection and Affordable Care Act (PPACA):

Your employer has always been and is still able to change coverage at will; but if you are covered now, you most likely will be insured in 2014. If your work-provided insurance ends, you'll be required to buy individual insurance, but you won't have to pay if you have religious objections or cannot afford it. In order to control the cost of premiums, by 2014, every state will have an insurance exchange so consumers can shop for their best plan and rates. 

Wow, you’d think the PPACA was full of rainbows, yellow brick roads, Emerald Cities, and happy Munchkins. Let’s untangle this and get back to real world:

Your employer has always been and is still able to change coverage at will; but if you are covered now, you most likely will be insured in 2014.

Oz and Roizen shouldn’t be so certain. Coverage might remain, but it might be much different. Modest changes to health insurance policies that are standard practice in the industry could make many plans lose their grandfathered status and be susceptible to all of the PPACA’s rules and regulations. There’s also the possibility an employer will quit offering health insurance. The McKinsey Group found that 30% of employers who were highly aware of the health care law might are considering this.

Continuing on:

In order to control the cost of premiums, by 2014, every state will have an insurance exchange so consumers can shop for their best plan and rates.

In theory, consumers will be able to buy insurance on exchanges. In reality, we have very little clarity as to how they’ll operate and who will run them. In the last few weeks, a number of states like New Jersey, Pennsylvania, and Tennessee (22 total) said they will opt out of running exchanges in their states, leaving it to the federal government. However, as The Hill reports, the federal government is faced with a daunting challenge:

“There's no way around it — this is a big job,” said Sabrina Corlette, a health policy expert at Georgetown University.

Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits-all fail-safe.

"You can't simply deploy one federal exchange across the board," said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

"Each state is different — their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state."

Every state must have an exchange by Jan. 1, 2014, meaning HHS doesn’t have a lot of time to do a massive amount of work. The department could quickly run through a $1 billion fund designated for implementing the exchanges.

Experts have predicted that the department will soon have to tap budgets from its other programs to cover exchange costs.

We do know that to pay for the federally-run exchange, the Department of Health and Human Services (HHS) wants to tack on a 3.5% fee on premiums of insurance sold in it.

As for controlling premiums, one of they purposes for pushing the PPACA on America, that won't happen.

While touting a bunch of benefits, Oz and Roizen fail to mention anything about the PPACA’s costs. For example, a proverbial flying monkey of the law, the mandate requiring businesses with more than 50 “full-time equivalent” employees to offer health insurance starting in 2014 will increase costs, cost jobs, and may push workers out of full-time jobs and into part-time employment

Tapping our heels three times won’t let us avoid the problems in this massive change to health care.

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