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Posted by
Olog-hai
on Fri Mar 21 12:25:08 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.
fiogf49gjkf0d NY Times
In Book, Architect of Health Law Predicts a Shift Away From Employer CoverageBy John Harwood
March 20, 2014Ezekiel J. Emanuel, who helped devise the Affordable Care Act, has a vision for how it will eventually work. Democrats hope it will not materialize anytime soon.
Mr. Emanuel expects the law to produce an unadvertised but fundamental shift in where most working Americans get their health insurance — specifically, a sharp drop in the number of employers who offer coverage to their workers. That scale of change would dwarf what took place last fall, when a political firestorm erupted over President Obama’s “if you like your plan you can keep it” pledge.
His former colleagues in the Obama White House say there is no evidence the law will bring “the end of employer-sponsored insurance,” as Mr. Emanuel puts it in his new book with the mouthful of a title, “Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.”
The law fines large companies that do not offer health coverage, but most have voluntarily offered coverage for many years. The proportion of Massachusetts employers offering health coverage actually increased when the state passed a similar health law a few years ago.
But now Mr. Emanuel thinks that a number of well-known national companies will break the mold and begin a trend. By his estimation, the proportion of private-sector workers who receive health care from employers will fall below 20 percent by 2025. Currently, just under 60 percent of private-sector workers get health care from employers.
“It’ll be a matter of a few big employers, blue-chip companies,” Mr. Emanuel said in an interview. “Then it’s going to be the norm.”
Mr. Emanuel, the brother of Rahm Emanuel, the mayor of Chicago and Mr. Obama’s former chief of staff, said that shift “will be a good thing” by helping control costs and enhance consumer choices. He concluded that “you might put it under positive, unintended consequences.”
Many health experts, both liberal and conservative, agree that it would be a good thing.
The American system of employer-provided health insurance was an accident of history spawned by wage controls during World War II. Employers were limited in giving employees raises, so many decided to reward workers with heavily subsidized health care instead. Since then, the practice has been widely blamed for limiting choice and accelerating health cost inflation.
Right now, an end to employer-paid health care is about the last thing Democrats want, especially as they face midterm elections in a defensive crouch after the administration’s bungled rollout of the health care law last fall. “It would be a big, big problem politically,” said Jonathan Gruber, an M.I.T. health economist who also advised the White House on the law.
Would-be health reformers have long struggled with how much change American consumers and voters will accept. In 2008, Senator John McCain of Arizona, the Republican presidential candidate, experienced the dangers when he proposed a plan eliminating the tax break for employer-provided health coverage — and faced blistering “tax increase” attacks from Mr. Obama.
As president, Mr. Obama intended his program to limit the number of changes required. He grafted expanded coverage and changes in the individual insurance marketplace onto the existing system rather than building an entirely new one. He also left mostly undisturbed the much larger employer-provided insurance market, which currently serves an estimated 149 million people. “If you’re happy with it and your employer’s happy with it, keep it,” the president said at one point.
But Mr. Obama included a feature sure to make some employers less happy: To help finance his plan and constrain health costs, he reversed course and supported a new tax, beginning in 2018, on the most generous health care plans that some large companies provide.
Mr. Emanuel argues that this “Cadillac tax,” along with taxpayer subsidies now available for Americans with modest incomes, will expand and accelerate the trend away from employer-provided health care.
Even though the health law’s “employer mandate” requires that companies with 50 or more workers pay a penalty of $2,000 per employee if they do not provide health care, many large companies now spend far more than that to offer coverage. As a result, Mr. Emanuel says they will be able to pay the penalty, give workers a raise and shed the burden of providing coverage by sending workers to the public exchanges.
“By 2025, few private-sector employers will still be providing health insurance,” Mr. Emanuel writes in his book.
So far, his view remains an outlier among health policy experts. “There’s not going to be massive erosion” in employer-provided coverage, Mr. Gruber said. Similarly, White House advisers argue that large companies will continue to view health coverage as a crucial competitive tool for attracting the best employees. The Congressional Budget Office has projected a comparatively modest drop affecting three to five million people annually by 2019.
Avik Roy, a senior fellow at the conservative Manhattan Institute who advised Mitt Romney’s Republican presidential campaign in 2012, said shifts would be most likely among retailers and restaurants with heavy concentrations of low-wage workers eligible for public subsidies. But if it happens, a large-scale shift would give Republicans a fat new political target. They would argue that Mr. Obama had once again expanded the role of government, forced taxpayers to subsidize a growing number of workers “dumped” onto exchanges and further misled the country to win passage of the law.
Mr. Roy hopes fellow conservatives will react with restraint, not out of sympathy for Mr. Obama but because the shift would bring a market-friendly improvement to American health care. “He did lie, and he should be held accountable,” Mr. Roy said. But, he added, “It’s a better world where people shop on their own.”
The caveat is that a switch from employer-provided health care will become an issue only if the public exchanges evolve into the easy-to-navigate, Amazon-style marketplaces the Obama administration promised in the first place. Mr. Obama says the public exchanges are operating smoothly as the March 31 deadline for 2014 coverage approaches, but for Mr. Emanuel’s vision to be realized, they have to be.
“A lot of that’s going to depend on how good the exchanges are,” said Mr. Emanuel, who now teaches health policy at the University of Pennsylvania. With consistent attention, he insists, government can solve the technical problems just as major retailers have.
“Zappos didn’t put up a website and go home,” he said.
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