The Healthcare Fixes Unfixed, Divide and Conquer on Display

Sofia    There’s no national healthcare in Bulgaria from what I learned in recent discussions, so this is a country where Americans can come to die and feel at home.  Think about that for a minute.  Living costs are relatively low.  Healthcare costs are relatively high.  Is this the world we want?  Perhaps so, because we seem headed for that situation, like it or not, ready or not.

Reading the morning papers on-line and getting past the Trump twitter tirades, the endless Russian hacking stories, and the usual grist for the mill, it was hard to miss a story in the Times that reminded us that no matter what small joy we may have harbored at the failure of the Republican Congress, the Trump project of starving the Affordable Care Act to death is making good solid progress around the land.  Worse for America, but probably great news in the West Wing of the White House is that it is yielding an even more politically beneficial result for the Trumpsters and the right wingnuts:  it’s dividing America even more.

I’ve ranted about the problems of lower waged workers suffering from the Obamacare loopholes and compromises that called them “covered” by the minimum standards of a healthcare plan if they were working for 50+ employee companies when their employers were allowed to say they were offering qualified plans with such absurd $4000 to $6000 deductibles and 9% of monthly income payments that literally NO ONE in many lower waged companies with hundreds of workers were electing coverage since it would suck up a huge portion of their checks when they were making $10 to $15 per hour.  More cynically, they were also barred because they were ostensibly covered by their employers from receiving any of the subsidies or shared cost assistance from the Obamacare marketplaces, so unless their states had expanded Medicaid, they were caught in the gap.   Nothing was sorted out in these years perhaps due to gridlock in Congress and perhaps because who really cares about low wage workers anyway?

Now in the Trump attack on the lower middle class, his starving of Affordable Care is leading, as predicted to soaring price and deductible increases on sketchy plans, almost identical to those faced by lower waged workers.  Families are seeing 50% or more increases in some states, and deductibles running up to $6000 before they are able to get benefits.  Now middle-income families are in the same boat as lower waged service workers where the cost of having insurance is creating a huge, sucking hole in their paychecks.

The shameful difference is that too many, if the Times’ report is to be believed, are not blaming Trump, the Republican Congress, gridlock, or anyone else.  They are blaming lower income families and – painful irony alert – lower waged workers.  Despite the fact that many families in both of these population segments are working their asses off at any and all jobs they can muster, this is now fueling support for even more draconian work requirements for the poor and lower income families access food stamps or even Medicaid benefits.

If that isn’t a master Machiavellian stroke approaching pure evil, what is?  Pretending Trump and his people are corrupt clowns may be satisfying to some, but as the Affordable Care fight shows, we’re in a death match now, and, friends, don’t fool yourself that we’re winning.

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The Affordable Care Act Needs to be Enforced by the IRS Now

New Orleans   These days everyone wants to talk about taxes, I get that, and that means the IRS, right? Sure it does, but while we’re talking about the IRS let’s talk about the fact that they need to get on the stick and enforce all the laws, not just the ones they feel like, and that means assuring full compliance with the provisions of the Affordable Care Act.

It’s important to never forget that the IRS holds the whip hand when it comes to enforcing the various rules and regulations of Obamacare. For individuals who were required under the individual mandate to buy insurance, they already know this full well, because penalties are being deducted from their tax refunds to cover their penalty. Arguably that’s almost a kinder and gentler way of being dunned because they are taking money from people before they have it their hands, get a good feel for it, and nurture any sort of loving attachment. In some cases, as we’ve pointed out before, for lower income workers it’s a better deal to pay the penalty than to pay a ridiculous amount of your annual income for high-deductible insurance providing bare minimum benefits by lower waged, service sector employers.

So the IRS is good at that part of their job under the Affordable Care Act, because the money is already sitting in the Treasury on a taxpayer’s account. Where they have been dilatory is in enforcing the mandate on employers with 50 or more employees who were required to provide insurance and decided to be scofflaws and just not do it. According to the Wall Street Journal, the IRS finally has sent out thousands of letters to employers going back to 2015 to collect penalties for noncompliance. It adds up, too. According to the Journal, “The Congressional Budget Office estimated in 2015 that employers would owe $9 billion in fiscal 2016 and $13 billion in fiscal 2017.” Maybe that’s not larger than their collective bar bill, but it’s big money and worth the climb to reach out and pull back into the Treasury. Remember as well, these businesses were stiffing their workers on their healthcare, and that’s invaluable.

That’s all great in my book, but there’s more to be done. The IRS is also supposed to be riding hard on nonprofit hospitals and whether they are really justifying their tax exempt status. This was an amendment generated by Republican Senator Chuck Grassley from Iowa, so it almost seems like a bipartisan requirement. There’s a death penalty involved, because the hospitals could lose their exemption by having neglected their charitable purposes. ACORN and Labor Neighbor Research & Training Center with the help of interns from Tulane University in New Orleans and the University of Ottawa have been examining hospital IRS 990s for years. We have found huge billionaire dollar medical institutions, many who claim to be good community citizens, only recording 1 to 2% for charity care, even when the average for such institutions nationally is about 4%. A back of the envelope estimate we have made is that an additional half-billion dollars in free care would be available for lower income families in Texas, Louisiana, and Arkansas, if all nonprofit hospitals even hit the minimum national standard.

The IRS needs to do all of their job under the Affordable Care Act. After years of hammering individuals, it’s good news that businesses are finally being called to account, but it’s past time for hospitals to either be charitable and really spend their money to provide care for lower income families or stop pretending and pay taxes to help pay for the Affordable Care Act.

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