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The Horror Of Mandates

Stanley Feld M.D.,FACP,MACE

A reader wrote;” I am getting tired of you telling me how bad the healthcare reform bill is.”

I am tired of writing about the bill. I feel compelled to try to clearly explain the harmful potential of the bill to an unsuspecting public.

Most Americans agree the country needs healthcare reform.

Many intelligent people believe President Obama is on the right track. They believe he is going to provide universal healthcare coverage, affordable healthcare cost, and improve the quality of medical care.

Few in the mainstream media are discussing the real impact of President Obama’s Healthcare Reform Plan.

President Obama cannot accomplish his goals with this bill. He is going to increase federal spending and taxes for every American’s not just the wealthy.

His healthcare plan is going to increase the power of the federal government at the expense of States’ rights. He is going to control American freedom of choice.

“In short, while the House bill doesn’t impose a single-payer, It does give federal bureaucrats – in this administration or any future administration – the power to impose precisely such a system without any further congressional action”.

“To add insult to injury, we would pay vastly more for this new system – a system even less responsive to patient preferences and choices than our current system. We would face higher taxes and, according to the Congressional Budget Office, higher premiums. Both the House and Senate bills penalize employers for hiring workers, especially workers from low-income families – the people who need help the most.”

How would the mandates in the bill harm all taxpayers?

The individual and employer mandates use taxes and penalties to punish uninsured Americans not help them. It also punishes small businesses who hire workers from low income families. It is most harsh on single parents whom it is suppose to help.

“If you wanted to punish the poor and kill the job prospects of people who need jobs the most, this bill would be an effective way to do it.”

President Obama opposed healthcare insurance mandates during his presidential campaign. His healthcare reform bill has two critical mandates. There are individual mandates and employer mandates. Both are very explicit and detailed.

The individual mandate has a euphemism called the “individual responsibility provision.”

“First, there is the “individual responsibility” provision in Section 1501 (pages 320-340). This would require anyone who fails to obtain a qualifying health plan – with a benefit package to be defined later by bureaucrats – to pay an annual tax penalty”

The Senate bill requires everyone to have qualified healthcare coverage between 2014 and 2016 as defined by the government. If they do not have a qualified healthcare plan the annual tax penalty will be $750 per adult family member and $375 per child, with a maximum penalty of $2,250 per family. The tax penalty will be indexed to inflation and will be based on family size, not income. The poor might qualify for an exemption.

The individual mandate in the House bill is worse than the Senate bill. The tax is 2.5% of the modified adjusted income. In either case it is a tax on the middle class. Government is mandating people to buy healthcare insurance against their will.

There is a hardship exemption if the bare bones healthcare insurance is greater than 8% of adjusted gross income. The trick play is you have to make less than $28,000 a year to qualify for the exemption.

The employer mandate also has a pleasant sounding name.

“There is the “employer responsibility” provision (Section 1511-1513, pages 346-357). Companies with more than 50 employees are required to offer qualified health plans – with a benefit package to be defined later by bureaucrats – to their full-time employees.”

Notice the tricks:

a. More than 50 full time employees.

b. Benefits defined later by non elected bureaucrats

The effect will be that small businesses will hire only part time employees. The employees will be mandated to buy their own insurance with after tax dollars.

The penalty for the employer will be $750 per full time employee. $750 dollars per employer is a lot cheaper than the $12,000 to $14,000 for healthcare insurance premiums for the employee’s family paid with after tax dollars.

If a full time employee qualifies for a premium subsidy in the “health insurance exchange” the employer will have to pay a tax penalty of $3000 for that employee. It is still cheaper than a full insurance premium. It will discourage employers from hiring full time employees. There are lots of ways this will hurt the poor. It will shift the burden to the employee.

Companies will be motivated to drop their health plans entirely, dumping all employees into the federal exchange at their own expense.

“In other words, employers will have a strong tax incentive to lay off the workers who need the jobs most – people without other sources of income.”

This is not a healthcare reform bill for the people. It is not robbing from the rich to give to the poor. It will make the poor even poorer.

Meanwhile, congress is not debating the essential elements needed to effectively decrease the cost of healthcare. The bill will not decrease the complications of chronic disease, promote early detection of disease or prevent its complications. The bill will increase taxes, decrease job creation, cause consumers to have less discretionary income and decrease American’s standard of living.

Write to the President and congress.

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The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.


  • Steve Keller

    Dr. Feld,
    Thank you for these postings. I agree with much of this article, and would like to suggest another cost savings not included in the bill: Malpractice limits. This would save tremendous amounts of money.
    Steve Keller

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