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.


The Zombie Apocalypse of Republican Health Care Proposals

Newark  I don’t really watch these “living dead” zombie shows, but I’m starting to get the picture by following the various Republican proposals to “repeal and replace” the Obama Affordable Care Act. Here’s my question though? In the movies and television shows are each generation of zombies more disgusting and worse than the ones that came before them?

Certainly that is the case with the so-called Graham-Cassidy bill to take one more shot at this for the right wing before they would have to obtain more than a simple majority of Senators to push these horrors onto the American people. September 30th is the “expire by date” on the Republicans ability to make mischief with 50 votes, rather than having to go bipartisan with a super-majority.

Let’s look at this version of the healthcare apocalypse though.

A spokesperson for Kaiser Healthcare said it was almost impossible to imagine a bill so bad that it hurt even more people and that had less support from anyone.

Blue Cross/ Blue Shield, AARP, and other insurers, who have been largely silent in earlier versions of the bill, have all mobilized to oppose this version because they argue it will wreck havoc with insurance markets by destroying a national system and making it a state by state battleground.

Thirty-six states will immediately get less money from the Graham-Cassidy bill, if it succeeds. The pain will be especially pronounced in some of the blue states like New York, California, and Oregon, and generally in those states that expanded Medicaid for their citizens, but even the fourteen states that might see themselves as “winners,” have to understand it’s only temporary. By the 2020s part of the impact of this bill is not the simple devolution of healthcare responsibilities and the money that pays for them from the federales to the states, but a cutting of Medicaid dollars period, which will create a huge hole in state budgets everywhere and reduce many red states in the South to the healthcare delivery standards of third-world nations.

Economists argue that even the sponsors of the bill don’t seem to have a clear idea what’s in the language. For example, Cassidy and Graham have claimed it continues to protect those with preexisting conditions, but reading the bill it’s just not in there.

There is no cost estimate on the bill from the nonpartisan Congressional Budget Office nor is there a score on how many will lose coverage under this bill. The best estimate is that 30 million will be pushed off of insurance.

So, why are we worrying that this zombie may end up ruling our world, rather than having a stake driven through its heart? God knows, but it seems to be just a case of politics divorced from the impact of health and harm to the public. The Republicans are so desperate to fulfill an absurd promise that they willing to pretend a mangy dog is Lassie on the way to save you.

If there’s something you can do, do it now, before this zombie stalks the land and leaves million dead or dying.