Ruth Marcus: The real hurdles in Obamacare

BY RUTH MARCUS Published: July 6, 2013
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Maybe it was the too-cute-by-half way the administration let slip the news about delaying the requirement that employers provide health care — policymaking by early evening blog post. Any announcement so deliberately low key had to signal bad news.

Maybe it was wishful thinking on the part of the health care law's legions of enemies. “This announcement means even the Obama administration knows the ‘train wreck' will only get worse,” chirped House Speaker John Boehner, declaring “a clear acknowledgment that the law is unworkable.”

Whatever the reason, reports of the impending death of Obamacare have been greatly exaggerated. Indeed, reports that postponing the mandate demonstrate that the law is too unwieldy to work have been greatly exaggerated.

Put another way, if you are a fan of the Affordable Care Act and worry about its implementation, or an enemy salivating at the prospect of its implosion, you should focus on other potential problem areas. Among them:

Whether the insurance exchanges will be up and running by Oct. 1 in a way that's accessible and comprehensible to consumers.

Whether there will be enough sign-ups by the “young invincibles,” who may believe they are impervious to the need for health insurance but whose premium dollars are essential to keeping overall costs low.

Whether — and this is perhaps most fundamental — it is possible to implement a change this sweeping and complex in the face of massive political resistance by states whose Republican governors decline to participate and by Republicans in Congress unwilling to consider legislative tweaks or to provide adequate funding for implementation.

In other words, of all the headaches facing Obamacare, the employer mandate isn't close to the most throbbing.

The essential mandate is the requirement that individuals obtain insurance. The parallel mandate that employers with more than 50 workers offer insurance was something of an add-on, a belt on top of suspenders. Without it, the law still works.

The reason is that most employers covered by the requirement — more than 94 percent, according to the Kaiser Family Foundation — already offer insurance. Their incentives to do so — to attract and retain workers, to take advantage of the tax-free nature of compensation in the form of health care benefits rather than salary — will remain, regardless of the mandate. Most employers will continue to play, whether or not they have to pay.

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