How will this "historic" health care legislation affect you?
I've been asking a lot of people close to me this question. And the answer I keep getting is a resounding, "I don't know."
"I spent 5 minutes looking at it this morning, and I don't see anything that will help with our health care costs, which run between $550 and $3,000 a month," said an Oregon suburban mom.
"Small-business owner unclear on health care impact" trumpets a USA Today headline. For nearly 30 million small businesses with almost 60 million employees, "it seems less a matter of being for it or against it and more a matter of not understanding what it means for them," the paper reports.
"When you're already overwhelmed with change and hear there's one more coming, you say to yourself that you'll deal with it tomorrow," says Jerry Jellison, a small-business consultant.
Pedro Alfonso, co-founder of Dynamic Concepts, a technology firm in Washington, D.C., told USA Today: "I am still a bit confused and a bit lost on some aspects of the bill and how it's going to affect me as a small business."
Well, then, what will it mean for big insurance companies like Cigna? "Unprecedented changes, all of which aren't really understood yet," David Cordani, Cigna's chief executive told The Washington Post. Even he, with his expensive lobbyists, doesn't know for sure what's in it for him?
If the CEO of a major insurance company can't tell how the bill will affect him, how can Josh be expected to know?
Josh is a former employee of mine who is one of the 8 million Americans who use a health savings account. Josh pays $260 a month for a high-deductible insurance policy that covers his wife and kids for any family medical expenses over $6,000 or more in one year. That keeps the premium affordable. He puts $5,000 in tax-deductible money into the bank each year to cover medical expenses, which includes emergency room visits, routine health care checkups, but also prescription eyeglasses, vitamins and (big-ticket item) dental care. His health savings dollars paid for the midwives his wife preferred to use in the birth of their two children, and also for some alternative medical treatments. He loves his health care saving account. And it's portable, not tied to his employment. Will he be allowed to keep it, like President Obama promised?
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"I don't know," he said, "I'll try to find out."
So I asked an expert, Roy Ranthum, who helped the U.S. Treasury implement health savings accounts when they were first enabled in the 2003 Medicare prescription drug plan, and now runs an HSA consulting business. Will Josh and 8 million other Americans get to keep their HSA plans?
"It's not completely clear," Ray tells me. I'm getting tired of hearing this answer. What? Nearly 2,500 pages of legislation and one of the nation's leading experts can't even tell Josh whether he's going to keep his health plan he loves? Why not? "It depends on regulations that the secretary of (Health and Human Services) will issue," Roy says.
Nobody knows, because the answer is unknowable -- it depends on what Kathleen Sebelius says.
That's right. You will be forced to buy the kind of insurance that the secretary of HHS decides you must buy. The rules will vary whether you are rich or poor, over 30 or under 30. It's complex. And the rules will be permanently unknowable with any certainty. Because, I ask Roy, doesn't that mean a new secretary of HHS can change the regs down the road? "Yes," he says.
This is truly history-making. Unprecedented. When Congress passed Medicare, people knew what it would do. The uncertainty pervading ObamaCare is not an accident, and it is not the fault of the press; it is the result of a deliberate strategic decision by the Democrats to have a bill that was less transparent than invisible, held off-stage until the last moment to prevent Americans from knowing what is in it. This decision to withhold an actual text until right before the vote was compounded by a further decision to delegate to a Cabinet official (can Congress even do that?) the regulatory authority to decide the key questions that determine how this bill affects millions of Americans. Can you keep your insurance? No one knows.
Radical permanent political health care uncertainty. Thanks, President Obama.
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