ACA Title 1, Sec 1552. Transparency in government: “Good” – but essentially meaningless. This section requires the Secretary to publish on the department’s website a list of all the authorities provided to the Secretary by this Law. Perhaps a symbolic gesture because of the complexity and number of legislative initiatives (450+) contained in the Law.

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ACA Title 1, Sec. 1515. Offering of exchange-participating qualified health plans through cafeteria plans: “Ugly” – Why exclude them? This provision does not make sense to me. It prohibits employers from offering “certain” exchange-participating qualified health plans from being offered through a Section 125 Cafeteria plan. I don’t understand why. Wouldn’t you want qualified health plans to be offered to employees through the tax advantaged form of a Section 125 cafeteria plan? Doesn’t make sense. I vote to get rid of this feature – if you want market competition enhanced across the board why not dump this limitation. Let qualified health plans compete in Section 125 offerings.

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ACA Title 1, Sec. 1514. Reporting of employer health insurance coverage: “Good” – Requires reporting of covered population. This provision is a reasonable requirement for all employers, not just “large” employers. If from a societal perspective we value health insurance coverage it makes sense to put in place a means of measuring it. The coverage information could be added to existing required IRS forms that all businesses file and added to individual tax return. Basic issue is if you are being irresponsible with regard to health insurance coverage then their should be some mechanism of accountability and some adverse consequence.

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ACA Title 1, Sec. 1511. Automatic enrollment for employees of large employers: “Good” – Improves extent of coverage. This provision assures an automatic process for covering all employees of organizations with more than 200 employees who provide health insurance coverage. This is good in that it should assist in eliminating interruptions in coverage sometimes associated with changes in employment. This provision does not appear to prohibit employers from requiring information or health risk assessments from employees or spouses as part of that automatic enrollment process.

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ACA Title 1, Sec. 1502. Reporting of health insurance coverage: “Good” – Required for implementation. This section establishes the authority for reporting of health insurance coverage information which is good, but it also requires a new and extensive reporting requirement for all employers, individuals and governmental entities. The shear flow of paper and information will be a new monumental federal requirement which will require a large number of federal staff to process and respond.

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ACA Title 1, Sec 1501 . Requirement to maintain minimum essential coverage: “Good” and “Bad” – Basic individual mandate requirement. This provision includes the legal requirement for individuals to maintain health insurance coverage, also known as the “individual mandate.” Congress made the case that health care is delivered and financed in an increasingly national market making it legally “interstate commerce” and extending legislative authority to require health insurance coverage. I personally support this requirement but not for the “interstate commerce” rationale. I believe that everyone should have basic health insurance coverage and should not create an unfunded liability because of their decision to not secure health insurance coverage. I believe that this is necessary to prevent employers and health plans who actively manage employee health care costs for their own populations from experiencing cost shifting from those who unfairly decide not to purchase health insurance coverage. However, I am also in favor of basic catastrophic coverage – for example everyone would be required to have publically provided health insurance that covers annual health care costs between $100,000 and $2,500,000 million each year per individual. I also believe that this coverage should be financed through tax payments for everyone who resides legally in the U.S. The coverage for the first $100,000 annually per individual should then be the responsibility of the individual and should be tax advantaged for everyone. Employers should have clear incentives to offer health insurance coverage to their employees and their family members.

This “first dollar” coverage should be highly competitive and employers would have a clear tax advantage to provide it to employees and their family members.

The annual penalty in 2014 of $96, 2015 of $350 and $750 IN 2016 is way too small to force healthy young adults to purchase health insurance coverage. This will further jeopardize the solvency of insurers and health plans and seriously undermine the implementation of the Law. Bad policy and bad approach to implementation.
Another provision that should be added to the Law under this section is the authorization for the reduction of premium contributions and penalties because of the personal wellness practices of each individual. In the absence of health plan specific wellness criteria a national set of wellness criteria could be used for everyone.

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ACA Title 1, Sec. 1421. Credit for employee health insurance expenses of small businesses: “Bad” – Needs to be better targeted and designed. This provision needs to be better targeted and simplified. It should allow businesses with less that 25 employees to qualify for a tax credit that is limited to 50% of the cost of health plan coverage for all employees. That 50% should decrease by 5% each year until in ten years it reaches 0%. The tax credit should be able to reduce federal withholding and provide a subsidy to small employers that disappears over time. This provision needs to be simple to understand and simple to implement and should provide financial support to small business organizations whether profit-making or non-profit.

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ACA Title 1, Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded for federal and federally-assisted programs: “Bad” – Further erodes individual role. This provision of the ACA smooths the federal and state eligibility process and simplifies the tax treatment of subsidies and cost reduction payments to beneficiaries. However, this overall provision still creates a very significant bureaucracy and makes the Law much more difficult to administer while having a minimal positive financial impact on eligible beneficiaries. Good administrative move for a largely unnecessary feature.

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ACA Title 1,Sec. 1414. Disclosures to carry out eligibility requirements for certain programs: “Good” – A necessary evil? This provision provides authority for the sharing of IRS individual taxpayer information among exchanges and the federal government for the purposes of determining the eligibility of the individual to receive subsidies, premium tax credits and cost reductions under the Law. I consider this a “necessary evil” because without it wholesale fraud would be rampant. At the same time I am certainly not comfortable with my own taxpayer information being placed in other federal and state hands, particularly when private business has such a difficult time keeping individual data secure, such as the Target data breach. Does this make you nervous?

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ACA Title 1, Sec. 1413. Streamlining of procedures for enrollment through an exchange and state Medicaid, CHIP, and health subsidy programs: “Good” – If it leads to simplification in program administration. This provision again makes sense on the surface. Let’s make the process of matching potential eligibles with the appropriate public program streamlined, but wouldn’t it be better if this also led to a simplification of those public programs? If Medicaid is undergoing a significant expansion and it already includes children why not roll the CHIP (Children’s Health Improvement Program) into it? The only reason we are maintaining it as a separate entity is so that a group of politicians/administrators can claim that they did something to help children. If the streamlining of eligibility determination can be carried out lets use it as an opportunity to reduce the sizable amount of duplication among health programs at the federal and state level. Make sense?

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