President Obama’s re-election and Democratic gains in the US Senate end any possibility of repealing the Obama health law. It will roll out as written, imposing major changes soon on you and your family. If you are uninsured because you can’t afford it, help may be on the way. But if you are one of the 250 million Americans with coverage, there are big problems ahead.
If you get your health insurance through a job, you might lose it as of Jan. 1, 2014. That’s when the new “employer mandate” kicks in, requiring employers with 50 or more full-time workers to provide the government-designed health plan or pay a fine. The government plan is so expensive, it adds $1.79 per hour to the cost of a full-time employee. That’s incidental if you're hiring neurosurgeons but a hefty increase for hiring busboys and sales clerks.
Currently, employers in retail and fast-food industries pay less than half that to cover their workers.To avoid thecostly mandate,some employers will push workers into part-time status. Other employers will opt for the fine. Either way, workers lose their on-the-job coverage.
Worse, they risklosingtheir jobs.Even the fine adds 98 cents an hour to the cost of labor, enough to make some employers cut back on their workforce.
As many as a third of employers are considering canceling coverage, according to McKinsey & Co. management consultants. But that doesn’t mean you’ll be uninsured; you won’t have that choice.
When you file your taxes, you will have to show proof that you are enrolled in the one-size-fits-all plan approved by the federal government. It’s mandatory, starting Jan. 1, 2014, or the IRS will withhold your refund. If you’ve been going without insurance, or your employer drops coverage, your options will be enrolling in Medicaid (if you’re eligible) or buying a government-approved health plan on your state health exchange.
What’s an insurance exchange? It’s like a supermarket that only sells cereal. The exchange will sell only the government-designed plan. In most states, exchanges will be an 800 number, a Web site and a government office, like the DMV. People with household incomes up to $92,200 will be eligible for a subsidy.
If you’re a senior or a baby boomer, expect less care than in the past. Cuts to future Medicare funding pay for more than half the Obama health law. Hospitals, for example, will have $247 billion less to care for same number of seniors than if the law had not passed. Hospitals will spread nurses thinner. California nurses already are striking over the increased workloads.
When Medicare cuts led hospitals to reduce nursing care in the past, elderly patients had a lower chance of surviving their stay and death rates from heart attacks rose, according to a report last year by the National Bureau of Economic Research.
For the first time in history, the federal government will control how doctors treat privately insured patients. Section 1311 of the law empowers the Secretary of Health and Human Services to standardize what doctors do. Even if you have a private plan from Cigna or Aetna and you paid for it yourself, the federal government will have some say over your doctors’ decisions, with an eye toward reducing health-care consumption.
If you sell your house and make a profit, you’ll likely be paying a new 3.8 percent tax on the gain. The law includes about half a trillion dollars in tax hikes, including a new 3.8 percent tax on gains from selling any asset, including your home, small business, stocks or bonds, effective Jan. 1, 2013. That’s on top of capital-gains taxes and applies to any profit that pushes your income over $200,000.
These changes are spelled out in the 2,572-page law, but many more changes will be imposed by regulations yet to be written. The Obama administration is adding federal workers at a rapid pace to churn out and enforce new rules. The government’s own projections say the cost of health-care administration — bureaucrats telling doctors and patients what to do — will soar from $29 billion when President Obama was first elected to $71 billion by 2020, some $40 billion dollars a year more in bureaucracy.
What a shame: That’s enough money to buy private health plans for fully half of all Americans who are now uninsured because they can’t afford it.
Betsy McCaughey, author of the new book “Decoding the Obama Health Law,” is a former lieutenant governor of New York.
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