We are only a few days away from the implementation of the Affordable Care Act - otherwise known as Obamacare.
On March 23, 2010, President Obama signed the ACA into law to applause and fanfare, vowing to increase the quality of health insurance, expand public and private coverage to lower the number of uninsured, and lower the costs for individuals, businesses, and government entities. Contentious legislation since its start - passing on a straight party line vote in the Senate and not receiving even one Republican yes vote - Obamacare has withstood multiple attacks from opponents, including a U.S. Supreme Court fight. Proponents during that time have defended it, calling the ACA the “law of the land.”
But a funny thing happened to Obamacare over the nearly four years since its becoming law. It bent. It delayed. It changed until a reasonable person must now ask how much of the original law still remains.
There have been 29 significant changes to Obamacare since March of 2010. Some of them were made by declaration by the Obama administration (12), others were passed by Congress (15), and two were the results of court decisions. While some of the changes by Congress had big effects - repealed the 1099 reporting for all vendors of $600 annually, repealed the Community Living Assistance Services and Supports which even Democrats referred to as a Ponzi scheme, cut off more funds to Lousiana that was considered a purchase of Sen. Landrieu’s yes vote, and extended coverage for dependent children up to 26 years-old - it was the 12 by the administration which had the most noticeable affects on the law:
1) Ordered advanced funding drawn for a Medicare bonus plan in order to keep people from dropping out. (April 19, 2011)
2) Delayed by one year the requirement that all employers report the full cost of health insurance on W-2 forms. (January 1, 2012)
3) Closed the federal high-risk pool in order to use the remaining funding to pay for advertising for Obamacare enrollment. (February 13, 2013)
4) Allowed the splitting of deductibles for multiple parts of the same plan, essentially doubling deductibles for some people. (February 20, 2013)
5) After reporting the federal exchanges for small businesses would not be created by the deadline, the administration delayed implementation of that portion of the law until 2015. (March 11, 2013)
6) Delayed until 2015 the Basic Health Program which would have provided affordable coverage for low-income individuals who did not qualify for Medicaid. (March 22, 2013)
7) Delayed the reporting requirements for employers by one year. (July 2, 2013)
8) Because a system had not been created, delayed the verification of income of insured. (July 15, 2013)
9) Allowed Congress and its staff members the ability to opt-out of the ACA. (September 30, 2013)
10) Delayed the deadline until March 31, 2014 for people to enroll in coverage to avoid the individual mandate tax penalty. (October 23, 2013)
11) After a public outcry over individuals who lost their policies because of the ACA, those who had not yet arranged for coverage were offered special “hardship exemptions” which could allow them to purchase catastrophic insurance plans. However, some Insurance Directors pointed out these plans were illegal by state law in some areas. (December 19, 2013)
12) Delayed the deadline for sign-up in the insurance exchanges by one day, citing the “time zone difference.” (December 23, 2013)*
Six of the administration changes were delays to deadlines in just the last year as the government struggled to complete nearly every facet of the implementation, including the creation of a functioning health exchange website. So what is the end result? More Americans have lost or have been notified they will be losing their health insurance coverage than have signed up for the new programs. The “indestructibles,” people in their 20s and early 30s, who were expected to shoulder a great deal of the burden of financing the ACA by paying higher premiums than their health insurance use would dictate have refused to sign up. Most people who have had their insurance plans changed or had the patience to use the government website have found their premiums increased even while their deductibles also rose.
So, when does a law change so much before implementation that it is hard to recognize as the original legislation? We do not have a definitive answer for that question but we are afraid Americans are about to learn the hard way.
(*List of ACA changes courtesy galen.org)