Obamacare again

I just read an article (see link) in the LA Times, a paper with some liberal bias, that suggests serious inroads into enrollment in the ACA (Affordable Care Act) or Obamacare as we move towards the deadline of 31 March.  Their analyst is suggesting between 3.65 and 4.73 million people have enrolled on the ACA website as of the beginning of March with about 75% having paid their first month premium.  This latter means that they are real enrollees, not just shoppers who left their carts and never signed up.  While a 25% reduction in the number of enrolled is significant, the total could be as high as 3.5 million with a month to go making the new (and flexible) goals of the administration within reach by the end of March.  Also, according to the article, the percentage of uninsured has dropped to 15.9% by the beginning of the month vs. 20% to start off.  Whether a 4% change in uninsured justifies the law's incorporation, it still represents a lot of people (and votes!) benefiting from this law (4% of 300 million is 12 million people and perhaps as many as 9 million votes depending upon demographics) 

Why do I care?  The GOP, who I favor over the Democrats, is pushing a "repeal Obamacare" message.  As more folks sign up, repealing this law becomes impossible.  Rather than focus on repeal of the law with statements suggesting it is a complete Federal takeover of the health system, the GOP needs to focus on moving the ACA focus from a complete takeover (which it only marginally is) to focusing on just federal health insurance reform which is amazingly popular.  This may be less of a matter for 2014 but it will be key for 2016.  If the Democrats find a way to believably declare victory, the issue could limit GOP gains in the house and senate in 2014 as well!

In any event, replacing Obamacare with health care spending accounts is a non-starter and neglects the entire theory of insurance.  If more provisions need to be made in the law for self-insurance, as is used by many major corporations, by individuals, I am sure that this could be addressed.

The more controversial provisions of the ACA  like the individual mandate could be eliminated in favor of a stiff late enrollment penalty for those not signing up.  There is a similar penalty for Part B Medicare that amounts to 10% for every 12 month period that goes by after you become eligible and the penalty is on every subsequent premium! 

The employer mandate may need to be tweaked to eliminate the 30 hour limit on employees.  While this might be opposed by employers, it would eliminate firings and/or reduction in part time employees' hours to keep under the limit.  To even the competition, something may need to be done to address the cost gap between the under 50 and over 50 employee businesses.  Whether that means extending the mandate to a smaller number of employees needs to be studied.  Of course it can be argued that if you have a competitive advantage because of health care costs, your business might grow to the point that the mandate would kick  in anyway so this might not be an issue.

Finally, the funding for the ACA is inadequate and the law adds to the federal deficit.  Several Republicans have proposed taxing employer-funded health care plans.  Although unpopular, this needs to be considered. If the full value of the employer contributions were to be taxed, the insurance costs could be added to the medical deduction on income tax, offsetting part of the pain but still reducing the ACA deficit.

Finally, the aspects of the law that rile the religious right could also be improved.  Things like contraceptives could be restructured within the law.  While this is a knee jerk issue for the left and might be decried as a war on women, a broader exemption for religious organizations should be written into the law.  For-profit enterprises like Hobby Lobby would have to comply.