Finally, the IRS is Enforcing Affordable Care Act!

New Orleans     How many times do we get to talk about good news and the IRS in the same sentence?  Darned few, and that’s not likely to change anytime soon.  But, having the IRS finally get off the dime and start enforcing the Affordable Care Act is fantastic news.  The bottom line is that they are making larger businesses step up and comply with the employer mandate to cover their workforce.  There are some other areas where they need to also toe the line, but we’ll get to that after we look at the business scofflaws.

The IRS piddled around with the employer mandate.  The Obama administration gave everyone a break for a year in 2015 because businesses were claiming they were just getting their arms around the law.  Then the IRS had to get their act together to figure out who was doing right and who was doing wrong, so the clock kept ticking longer until they mastered the equation in late 2017.   Now with one-third of 2018 ticking off the clock the IRS has sent out notices to more than 30,000 businesses with penalty letters for the 2015, and they are ginning up to get the penalty notices out for 2016 and 2017 tax years PDQ.

Remember the employer mandate meant that companies with more than 50 full-time workers had to be provided with health care or face fines of more than $2000 per worker.  Keep in mind that we’re talking about 1,500,000 workers at a minimum that should have been offered health care but weren’t.   Odds are that many of these companies thought they were getting away with it and are likely to face penalties for the subsequent years as well.  Now that they are being caught, these bum outfits are screaming like stuck pigs.

Should we feel even one iota of sympathy for any of them.  Heck no!  Especially since the Act did not put caps on the deductibles, so that many companies complied by offering these so-called “skinny” plans that met the minimum standards on paper, but whose $4000 to $6000 deductibles made the plans worthless and unaffordable to the individuals given the small amount they were making on their jobs.  The companies then qualified and escaped the penalties, the workers were barred from the shared costs in the marketplace, and there was often zero participation by workers costing the companies nothing at all.  With loopholes that large any company so heedless of either the law or its workers should absolutely pay the full weight of the penalty.   Let’s make sure they do.

Now if the IRS would also jump on the huge, tax exempt nonprofit hospitals that are cheap skating their charity care and enforce the requirements that they step up or lose their tax-exempt status as required by the Act, we would see some health care going to low income families that desperately need it.  Many of these families work for these same selfish companies, so it is time to square that circle.

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Inequality Breeds Epidemics and Can Kill More than Just the Poor

City of San Diego sprays bleach solution at community park after Hepatitis A outbreak. Source: Eduardo Contreras /San Diego Union-Tribune

New Orleans    Spoiler alert.  There is not a happy ending to this story without wide scale change in inequality.  Turns out that not only is the wealth and income gap destroying our democracy and much of the social fabric of our lives and communities, but it is also breeding infectious diseases that leap past the boundaries of even the fattest wallets.  If you ever want to read a real horror story of our times, go past the front pages of the daily papers and steel yourself for a deep dive in harsh reality and abject fear, which I found in Scientific American in a recent article entitled “American Epidemic” by Melinda Wenner Moyer.

Admittedly, I couldn’t resist the article because I’ve been on a regular route through Detroit every few months recently, and that’s where Moyer begins her piece at the Tumaini Center, a crisis support center there for the homeless, where people literally live in chairs, not only lacking real shelter, but denied even a bed.  The center becomes the setting for the battle against a hepatitis A epidemic that has been the largest since a vaccine was introduced in 1995.

The heart of the problem becomes clear in the piece quickly as Moyer writes,

There are many causes for these rising infectious tides, but researchers agree that a major driver is the country’s ever worsening income inequality…The number of households earning less than $15,000 a year grew by 37% between 2000 and 2016…In poor areas where almost half the people live below federal poverty levels, populations doubled during this period.  People on these bottom rungs of society’s ladder live in crowded, often unclean conditions, have limited health care, must work when sick, have poor nutrition, experience debilitating stress, and are more likely than others to abuse drugs and alcohol – all known infection risk factors.

Got the picture?

Furthermore, you can run, but you can’t hide.  Urban spaces are increasingly crowded.  Public transportation puts people together.  Only the superrich can live in a bubble, and anyone who has flown on a plane in recent years knows how easily one can pick up a bug and carry it around the world.

Walking across the street to avoid the homeless won’t protect you either.  Eating in public also exposes many to infectious epidemics.  Moyer points out that,

The working poor in urban areas are also uniquely positioned to spread infectious diseases because of job conditions.  More than one million low-income Americans work as food preparers, which pays an average of $13,200 a year.  Many of these workers go in even when they are ill.  In a 2015 study, researchers at state health departments interviewed 426 restaurant managers around the country and reported that many of the restaurants’ policies regarding working while ill violated the US Food and Drug Administration recommendations.

Add the fact that older and crowded buildings can create SARS types of infections based on design and architectural flaws and just plain lack of maintenance, and the list goes on and on.

There’s no way to miss the message.  Inequality is a public health catastrophe that could kill us all, rich and poor, big and small.

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