Monthly Archives: September 2013

Is Paying the Obamacare Tax a Better Choice for the Young and Healthy?

Urgent Update and Correction:

Just as with this article at Business Insider, I missed the fact that enrollment in the exchanges is limited to open enrollment periods.

This does change the risk dynamics of paying the tax rather than buying the insurance.  Any confusion caused by this oversight is regretted.  Even still, those with either few assets to lose or those with sufficient assets to carry them to the next enrollment period, may still want to take the risks as presented in the original post.  The availability of sensible catastrophic true high deductible “real” insurance that Obamacare prohibits and has not been offered in the states would be the answer to this dilemma.

Original Post (with slight unrelated edits):

The following discussion is in no way intended as specific advice as everyone’s situation is different and unique to them, but only as a guide to uninsured young and healthy individuals to understand their choice in whether to buy health insurance on an Obamacare exchange to avoid paying the tax or paying the tax to relieve them of the obligation to purchase the insurance.  The only mandate for the uninsured is to make this choice, not to do one or the other.

The other purpose here is to counter biased government efforts that will insist the only choice is which insurance exchange plan to buy and how to sign up for it, ignoring the possible benefit of paying the tax instead.  This government effort is substantial, as here in Pennsylvania alone, over $6 million of taxpayer money is being directed to one critical thing Obamacare success is dependent on, enrolling as many young and healthy people as possible.  According to Enroll America-Pennsylvania, on July 10, 2013 “health centers in Pennsylvania were awarded a total of $4,196,333 to provide outreach and enrollment assistance.”  They also indicate that an additional $2,071,458 is coming soon to organizations that will act as “Navigators” who will likely never discuss the non-insurance option that is also important for the young and healthy to understand in making their choice.

Young people need to know a few facts of Obamacare at the outset.  Because the law limits charging the old and less healthy more than three times what the young and healthy pay, this shifts more burden to the young.  Offsetting this are premium subsidies to make the insurance choices seem affordable, but as the young advance their careers and their earnings these subsidies fade.  Another important consideration is that shortsighted bureaucrats designed Obamacare to allow no exclusion for previously existing conditions, giving the opportunity to purchase insurance after the onset of a serious illness, even from a hospital bed. Update: Still true, but only if during a subsequent open enrollment period.

The pay-the-tax choice may be useful for young and healthy people who have the discipline to put aside the difference (compared to paying exchange premiums) for their basic normal medical needs, and especially if they then find one of a growing number of physicians offering much lower prices by casting off third party payment for a cash practice.  It must be understood that this choice is not without the risk of an occurrence of a sudden and severe medical condition causing total incapacitation.  This extremely rare event could prevent them from signing up for insurance on an exchange until they are sufficiently recovered to do so.  Update: So long as it is within or until the next open enrollment period.

Putting the sudden-and-severe risk in perspective though is important.  Everyday young healthy people take on huge amounts of student loan debt, with no guarantee of acquiring a job sufficient to easily pay it back, even as student loan debt obligations saddle the borrower for life because  they are not dischargeable in bankruptcy.  Medical debts, on the other hand, can be eliminated through bankruptcy should the highly unlikely occur.  This is where an option to pay the tax and buy a very low cost non-Obamacare compliant policy that pays nothing up to perhaps a $10,000 or even $15,000 deductible, then covers everything above that, would be so useful, but no such thing exists.  Such a plan would be good enough to prevent bankruptcy in most cases and leave substantially less obligation than many young people have willingly taken on with student loans.

It is thus important for young healthy people to see the big picture, understand all their options, then act in their best interest, in reaction to the rules presented to them by the Affordable Care Act.  This discussion has been meant as a guide in starting the navigation of that process.  Additionally, there is a wonderful new resource blog, The Self -Pay Patient, that unfolds a myriad of already available but little known alternatives to insurance, and I highly suggest a visit for anyone serious about learning the many other options available to them, since no government navigator will ever mention any of it.

Note: This post was shared to WatchdogWire

REINS Revolution as Ransom for Budget Resolution?

REINS

Herd mentality on issues is not something unique to the political Left or the political Right, but in either case populist tendencies can be downright dangerous, leading to unintended consequences.  No matter how good an idea seems at the outset, it is always good to ask what could go wrong.  Zealotry interferes with this basic question and places pressure on those who may doubt the wisdom of an idea, risking indignation from those they consider allies,  to remain silent.  Principled people will resist this temptation to go along to get along, making known their objections, explaining why, then letting the chips fall where they may.

We currently see herd movement on the Conservative side, with the attempt to defund Obamacare by making it ransom for cooperation in passage of a continuing budget resolution in order to keep the Federal government functioning past September 30.  Looking around, there appears to be unanimity among the grassroots on this issue.  Freedom Works, Heritage Action, Tea Party Patriots are all on board, being led by Senators Ted Cruz and Mike Lee among others.  Ads on Hannity and Rush and the Blaze are all promoting defund.  A rally at the capitol has been planned for September 10 and busloads of protestors will be making the trek.  “Exempt America from Obamacare” is the cry.  Yet there are a small handful of dissenters, myself among them, warning of the potential foolishness of this approach.

Jennifer Stefano, head of the Pennsylvania chapter of Americans for Prosperity, minced no words in her August 9 op-ed for the Patriot-News and Pennlive.com.  She boldly said that those “pushing the ‘defund Obamacare or shut down the government’ fight are wrong.  One hundred and ten percent wrong” and to conservatives, “your government shutdown approach has got to stop.”

Following that, on August 14 Avik Roy of the Manhattan Institute, and one of the foremost opponents of Obamacare and defenders of market based healthcare reform solutions, published an op-ed in National Review Online.  Wasting not a second, his title read, “Obamacare’s Shutdown Shock-Jocks  Ted Cruz and Mike Lee have a plan-to make Obamacare permanent.”

Neither Stefano nor Roy suggest anything that might confound the atrocity of Obamacare is a bad idea.  Both do suggest, however, that tying defunding to the budget resolution has the potential to backfire big time.  They both point to polls showing little public support for shutting down the government.  Supporters try to say that it would be Democrats and Obama shutting down the government, not them.  Obama and the Left, of course, along with a complicit media, will rail against the Republicans and Conservatives in particular.  With the current political realities, a festering shutdown deadlock in the face of unfavorable polls would be  the likely outcome.  The implications of this would then likely carry a price, perhaps a heavy one, going into 2014.

So back to political leverage in connection with allowing the federal government to continue operating past the end of September: There is one thing on which conservatives could only win.  Tie any budget cooperation to passage of the REINS Act.  The what?  Exactly!  Use it as ransom for cooperation.  There are no illusions REINS would actually pass, and backing away short of a government shutdown would be necessary, but after weeks in the spotlight, everyone who pays even a small amount of attention to politics would have a good understanding of a brilliant concept, of which too many conservatives are still unaware.  That alone could be a huge victory.

Briefly, the REINS Act would put limits on an out of control trend toward legislation by regulation (or regulation as legislation), whereby departments and agencies can make things up as they go, despite the economic impact on those who must comply.  Under REINS any regulation with implementation impacts greater than $100million (including Obamacare) would require the consent (and accountability) of Congress.  This puts REINS in a very special class of ideas that seek to step away from an overly powerful central government, rather than stepping further into it!  In that respect it is a revolutionary tool of disengagement from bloated central authority.  Promoting such a concept, showcasing the REINS Act, would define and position the GOP going into 2014 as the party of limited central government in a way that may force a discussion the Left would rather not have or expect.  Contrast this approach with the risks of tying defunding Obamacare to the continuing resolution, especially when defund or delay can still be pursued (and should be) via general orders apart from any budget resolution.

Additionally, the Obamacare mess has been speaking badly for itself lately, to the extent that, along with parts that have already been delayed, even Democrats and disenchanted labor unions may find total delay palatable before long.  Avik Roy pointed out, because defund, even if possible, would extend only one year or the length of any budget resolution, it and delay are really the same.

A wonderful description and  history of REINS, followed by examples of federal government excesses that demand it, can be found in Phil Kerpen’s 2011 book Democracy Denied.

Originally introduced in the 112th Congress, REINS has been reintroduced in the current Congress as HR 367.  It passed the House on August 2, 2013 by a 232-183 vote.