Saturday, February 16, 2013

Here to stay...  

But maybe not in its present form. While opponents of Obamacare still rage about its existence, the work of learning to live with it is picking up speed.  While it might seem this kind of debate/compromise could have occurred at the outset, I'm convinced that is a pipe dream. But with deadlines looming when the BIG milestones such as universal acceptance will really, really happen, the health care industry and government are moving to comply, even if grudgingly. Moreover, I'm betting we kludge this thing around to workability pretty fast.

In the process, thoughtful ideas and experiments could ease many of the most inefficient aspects of the law.
Of all the companies worried that the Affordable Care Act will be bad for business, H&R Block may lay claim to the most unique gripe.
The firm prepares millions of tax returns, one of every seven that gets filed to the Internal Revenue Service. The vast majority of its consumers receive a refund; all told, their 26.5 million customers received $50 billion in refunds in 2012.
The Affordable Care Act could change that: It charges a tax penalty to Americans who do not carry health insurance coverage. And that has H&R Block worried that some of those refunds will get eaten up – with a lot of angry customers pointing a finger at them.
“Eighty-five percent of our customers get a refund,” Kathy Pickering, who directs the H&R Block Tax Institute, says. “That refund could be offset by the penalty. And if that happens, they’re going to be understandably angry.”
Last year, the company started thinking about how to curtail those types of surprises; they did consumer research to understand how much people knew about the law, what they liked and what they didn’t.
Now, during this tax season, H&R Block is rolling out a Health Care Review product, a no-charge assessment of the subsidies and penalties they will likely face in 2014.
The health law’s subsidies for insurance coverage and penalties for not carrying a plan don’t start in 2014. But the income that will determine how big of a subsidy an individual or family will receive — that’s the income that’s being filed right now, in 2013. [More]
Given the intense tax-prep warfare being waged now, I don't see that being a stand-alone strategy got Block.  Meanwhile, governors are analyzing the new laws to see how best to respond. While this could simply gaming the system, it represents how we can best implement admittedly imperfect rules to get better results.
Wisconsin’s Scott Walker recently became the 13th governor to turn down federal money to expand Medicaid, opting instead to move Wisconsinites between 100% and 200% of the poverty line into the ACA health care marketplaces. [More of good two-sided coverage of this effort]
This reminds me of all the work by seed companies, land investors, and farmers to manage climate change on their own microeconomic level even as they deny much of the evidence for it.

People deal with reality, but they are not required to acknowledge they might have been mistaken or even cease to be irritated. Obamacare seems to be more permanent as an idea every day, but like the rest of our social safety net, it will constantly be evolving.

I still say opponents will rue the day they attached the President's name to it to capitalize on the antipathy toward a person. Universal health coverage will become as strong an entitlement in the public mind as Medicare or SS.  

Or crop insurance. We all demand a little socialism just for us.

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