What The Latest Obamacare Delay Could Mean To You


ImpedeFirst, a reminder of high school civics.  The way the U.S. Constitution was written Congress was given the authority to make law.  The President, as Chief Executive, was supposed to see that the laws that congress made were implemented.

Somewhere in the last 224 years something changed.  The current president is acting like congress is merely an advisory body and he is free to ignore their laws.

Unlike the press, I am not qualified to speak to any questionable activity by our president on other matters.  However, I am a health insurance agent.  I have paid very close attention to Mr. Obama’s attempt to reform the health insurance industry since 2008.

I did not trust candidate Obama then and he has failed to earn my trust since he was elected President.  My objection is not based on the color of his skin or anything he has said.  I do not care for his actions.

Since the Patient’s Protection And Affordable Care Act was forced into law in 2010 against a very vocal opposition, the President and his Secretary of Health and Human Services have missed several deadlines and totally ignored a major section of that legislation.

  1. The SBC forms that were supposed to make comparison shopping for health insurance were 6 months late.
  2. President Obama unilaterally suspended work on Title VIII of the law in December, 2011 without consulting congress.
  3. President Obama insists that what the U.S. Supreme Court calls a tax is not a tax.

The latest “delay” is for the Small Business Health Option Plan (SHOP).  Last month Mr. Obama announced that his Department of HHS has not had enough time to do what congress told him to do.  He has decided, without any input from congress to ignore the time-table that congress gave him and do only the things that he wants.

Supporters of Barack Obama claim that he was set up by congress to fail.  They forget that the same congress that forced Obamacare on America did nothing that was not approved by Barack Obama.  They claim that 3.5 years is not long enough to fulfill the aggressive time-table that was approved by Barack Obama and has his signature on it.

The fact is that he failed to do what he promised to do in the time he agreed to do it in.  He and his supporters are free to make all the excuses they want but all that it proves is that Barack Obama is in over his head and cannot be trusted to perform things as he promised.

The PPACA, that congress approved reads,

“IN GENERAL.—Each State shall, not later than January 1, 2014, establish an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’) for the State that—

(A) facilitates the purchase of qualified health plans;

(B) provides for the establishment of a Small Business Health Options Program (in this title referred to as a ‘‘SHOP Exchange’’) that is designed to assist qualified employers in the State who are small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State; and

(C) meets the requirements of subsection (d).

(2) MERGER OF INDIVIDUAL AND SHOP EXCHANGES.—A State may elect to provide only one Exchange in the State for providing both Exchange and SHOP Exchange services to both qualified individuals and qualified small employers, but only if the Exchange has adequate resources to assist such individuals and employers.”

WHAT DOES THIS MEAN IF YOU LIVE IN A STATE WITH AN EXCHANGE?

This latest “delay” will not effect every American.  Exchanges will be formed by individual states in 17 cases.  Those states will have both an Individual and SHOP exchange in order to be compliant with the law that congress adopted.

If you live in a state that will have its own exchange, you can stop reading this post now.  You can continue serfing the internet.  The rest of this post has information that does not apply to you.

However, I do ask that you scroll down to the bottom of this post and subscribe to my email before you move on.  That way, I can keep you informed on what is happening with Obamacare, what is required for you to do and when you must do it.

WHAT DOES THIS MEAN IF YOU LIVE IN A STATE THAT HAS A FEDERAL EXCHANGE?

However, if you live in a state that will have a federal exchange, you may be effected.  Only state based exchanges have the authority to combine the individual and SHOP exchanges.  Federal exchanges must have both options in order to be compliant with the law.

Thirty-three states, including my home state of Texas, have declined to spend the time and money necessary to form state based exchanges.

(I do not claim to be a political prophet, economist or a member of the national press.  I am just an American citizen.  In my opinion, that is the right thing for state governments to do.  I do not see the wisdom in spending so much money and effort to design a program that has a very good chance of being repealed with the next presidential election in favor of a more efficient system.) 

The exchanges that will be made available to those citizens will be run by the federal government.

The PPACA establishes January 1, 2014 as a firm dead-line for SHOP.  It is not a suggestion.  It was supposed to be something that Americans could count on.  Unfortunately, rather than doing what she was instructed to do, Mr. Obama’s Secretary of Health and Human Services, Kathleen Sebelius has spent more time leading cheers and writing poison pen letters to insurance companies than doing what she was instructed by congress to do.

Mr. Obama calculated that once the PPACA was passed, most of those who opposed the state-based exchanges would drop their opposition and bow to federal power.  He assumed that his administration would only need to build 6-7 exchanges.

He calculated wrong.  Those who opposed him while he was using political tricks to force passage of his “Legacy Legislation” through congress are now able to say, “I told you so” or as Sheldon Cooper would say, “I informed you thusly.”

With 33 states abstaining from building state sponsored exchanges, the Department of Health and Human Services must build a different one for each state.

CAN YOU EXPECT AN EXCEPTION?

The rules for the exchanges have already been established.  An individual is ineligible to buy a mandated Essential Benefit Plan from an exchange if they are offered participation in a group health insurance and the premium is less than 9% of their household income.

The SHOP plans were supposed to let employees chose to pay more than the employer’s contribution if they want a better Essential Benefit Plan.  That will not happen in 2014 as scheduled by congress.

As the rules stand today, if an employee wants something different from what his employer provides for himself, spouse or children or an employer wants to shop for group health insurance, it must be done outside of the exchanges.

Since it was the Obama administration that has delayed the SHOP exchanges, it would only make common sense that the federal exchanges would exempt people from the rules that prevent people who have access to group health insurance.

Unfortunately, I have not seen much common sense come out of D.C. for several years from either political party.

I’m afraid that we will have to wait until later this summer to see what, if any, adjustments will be made to the Individual exchanges for 2014 since there will be no SHOP.

Each week I send an educational email to my clients.  That way I can keep them informed on what they need to do and when they need to do it.  Click the banner below if you would like to be subscribed to that email list.

Subscribe 1

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s