Thursday, January 22, 2015

Barack Obama, 2015, SOTU, Physician Shortages and Tax Consequences

Part 2

In Part 1 we dissected important parts of the Affordable Care Act (ACA, known as Obamacare) that have not yet hit the American public in the proverbial gut but which, in our opinion, reflect a flurry of body punches that's just around the corner. In due course, the IPAB (Independent Payment Advisory Board) will be obliged to act. Keep in mind that the IPAB used to be known as the IMAB (Independent Medicare Advisory Board) which got scuttled when Medicare's constituency realized that it was aimed straight at them  -- then it was reconstructed in the ACA with a name-change. 

The president boasted that about 10 million uninsured Americans were enabled to sign up for health insurance under the ACA. What the president didn't tell us was which health care plans including Covered California did not have enough physicians to cover expected demand. He did not disclose the looming physician shortage that healthcare plans anticipate. By way of personal anecdote, my own personal doctors display signs in their waiting rooms that they don't accept Covered California. In a nutshell, Covered California subscribers and subscribers to many of the ACA plans technically have coverage under their plans; but the plans themselves don't have enough physicians.  The president could have advised potential subscribers to make sure that health care plans include the physicians we trust and rely upon. 

Not to worry. There is a solution although maybe not one that many will like. Covered California and the ACA-enabled plans need not retain physicians if they can fill their ranks with physician assistants, nurses, and eventually nurses with doctorates in nursing practice. All the plans need to do is fulfill the legislative mandate with so-called healthcare providers which can include nursing assistants and other non-physician personnel. Some subscribers will feel they've been swindled, but it'll be too late to make significant changes. Then the president will be an ex-president on high-priced lecture tours. 

But the more imminent surprise will be taxes. It has been stated all along that there may be tax consequences in addition to a fine that has been touted as the likely penalty for non-subscribers who seek coverage.  With the 2014 Tax Year payments looming,  we now know that many Americans will face penalties when they file their returns and that these penalties will reflect aspects of the ACA legislation. The president could have advised American taxpayers to check out this contingency before filing their 2014 returns. Instead, he left them in the lurch.

Many of us expected better. It will not be our last disappointment. 

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