Showing posts with label Healthcare. Show all posts
Showing posts with label Healthcare. Show all posts

Saturday, August 17, 2013

Obamacare Will Bring Britain's Health-Care Problems To U.S.

For years I have been writing about the failures of the United Kingdom’s National Health Service as a warning for what the Affordable Care Act will do to health care here in the U.S.

London’s Daily Mail has chronicled the problems with the NHS, which include declining quality of care and availability of services coupled with increased costs. This is what is in store for us, if Congress does not repeal Obamacare.

According to the Daily Mail, “NHS hospitals are recruiting Spanish and Portuguese nurses in record numbers while British applicants are being refused because places on training courses have been slashed to cut costs.” More than 5,000 student nurse places, it writes, “have been axed since the General Election.” The reason? Foreign nurses cost less. Incredibly, they won’t be checked to see if they can speak English. The potential for confusion over medication and treatment because of language differences could be significant.

Another Daily Mail story is about Stewart Fleming, a man with severe stomach pains who waited six hours in a hospital cubicle because, said Andrew Horne, chief executive of Medway NHS Foundation Trust, “that evening was very busy; the hospital was full.” The 37-year-old father of two died.

The Daily Mirror reports that at Stafford Hospital in Staffordshire, 1,200 patients died over a four-year period. No one has been held accountable, but the person in charge of the health authority for part of that time, Sir David Nicholson, was promoted and for two years headed the entire NHS at a substantially higher salary.

In a cruel irony, Donald Berwick, the former U.S. Medicare administrator, who has said, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open,” now heads a committee tasked with preventing the NHS from causing harm to patients. That’s easy: get rid of the NHS.

A 2010 column by the Daily Telegraph’s Janet Daley ran with the headline, “Copying the NHS is the last thing the U.S. should do.” She called instead for a “combination of state provision and private contribution” for health care.

The NHS should have been a lesson for the United States. After promising that Obamacare would not raise insurance costs, we are now seeing the reality. Daniel P. Kessler, a Stanford University professor of law and business, recently noted in The Wall Street Journal, “Despite what you read, premiums in Oregon and California are going up, especially for the young.” Other states, should they participate (and many say they won’t ) will inevitably have the same experience.

The Internal Revenue Service, which will enforce Obamacare’s individual and employer mandates, announced in February, according to CNSNews.com, that the “cheapest health-insurance plan available in 2016 for a family will cost $20,000.”

CNBC, citing a survey released by InsuranceQuotes.com, a company that allows people to compare insurance rates, recently reported that 64 percent of uninsured adults say they haven’t decided if they will buy insurance by the Jan. 1, 2014, deadline.

What happens here if people begin to experience long waits for treatment, higher costs, fewer doctors and nurses whose English is poor? Will they rebel or passively accept an unworkable system?

Two friends who live in a retirement community in Washington recently told me of a change in their nursing staff. The majority are now from West Africa. This change, they say, has made many residents uncomfortable and uncertain whether the nurses are competent enough to provide the quality of care they have come to expect.

During the Depression and the rise of fascism in Europe, Sinclair Lewis wrote the novel It Can’t Happen Here. It was his warning about how fragile democracy is and how easily it can be replaced by dictatorship. Obamacare has the potential for becoming a type of dictatorship.

The negative consequences from the NHS can happen here, and they are on the way, unless Republicans win enough congressional seats next year and then vote to replace Obamacare.

Cal Thomas writes for Tribune Media Services.

tmseditors@tribune.com


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Wednesday, July 31, 2013

Insurance Tax In Healthcare Law Could Cost States $15B

Groups on both sides of the healthcare debate are lobbying Congress to scale back a tax in President Obama's healthcare law that could end up costing the states billions of dollars.

Supporters and opponents of the healthcare law are both eyeing changes to the law's tax on insurance plans, which could cost the states nearly $15 billion.

The Affordable Care Act includes a new excise tax on insurance plans, and the tax applies to the privately managed Medicaid programs many states use. Taxing Medicaid managed care plans could force state governments to pay the tax.

The Republican Governors Association (RGA) raised the issue in a recent letter to congressional leaders, saying the tax "merits your urgent attention."

A report from the Milliman consulting firm estimated that the tax would cost state governments between $13 billion and $15 billion over the next decade.

Insurance companies have lobbied for years to repeal the insurance tax altogether, saying it will raise premiums across the board. The fee was included to help pay for the cost of expanding insurance coverage.

But RGA Chairman Bobby Jindal (R-La.) and Vice Chairman Scott Walker (R-Wis.) opened the door to a narrower option in their letter to lawmakers, asking only for Congress to exempt Medicaid and the Children's Health Insurance Plan from the tax.

"As Congress considers deficit reduction and tax reform, we urge you to amend (the Affordable Care Act) to exempt all Medicaid and CHIP premium revenue from this fee," they wrote.

Some of the law's supporters are also on board. The National Urban League is trying to build support for an exemption among other groups that support the health law's Medicaid expansion.

States that realize they'll bear new taxes on their Medicaid plans might be less inclined to expand the program, the Urban League said.

"We recognize that revenue mechanisms, including fees, are critical to achieve the savings that the ACA aims to accomplish," the group wrote in a letter to the National Council of La Raza. "However, due to the possibility that the fee may restrict the ability of states to expand their Medicaid programs through insurers that provide Medicaid and CHIP coverage, we believe that an exemption for these plans should be considered."

At least for now, the lobbying push around the health insurance tax remains focused mostly on full repeal. Joe Moser, director of government affairs for the Medicaid Health Plans of America, said his organization is not lobbying for an exemption, but rather is still focused on full repeal.

A narrower exemption could also be a hard sell for large insurance carriers. The insurance tax is structured as a flat fee — it has to raise a certain amount each year — so carving out Medicaid managed care plans would raise the tax burden for other insurance plans.

Nevertheless, Democrats have shown an increasing willingness to modify the healthcare law now that its basic survival has been assured. 

A non-binding measure to repeal the law's tax on medical devices won overwhelming bipartisan support in the Senate last month, and the White House has agreed to cut funding for certain programs as part of various spending and deficit-reduction bills.

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Monday, July 29, 2013

Laura Ingraham: Celebrities Can Talk About Fracking But a Neurosurgeon Can't Discuss Healthcare

Noel Sheppard's picture

Conservative talk radio host Laura Ingraham on Tuesday made a marvelous observation about the media firestorm surrounding Dr. Benjamin Carson's speech last week at the National Prayer Breakfast.

Appearing on Fox & Friends, Ingraham said, "We can have celebrities talk about fracking and all sorts of political issues...but the head of pediatric neurosurgery at one of the top hospitals in the world" shouldn't discuss healthcare (video follows with partial transcript and commentary):

LAURA INGRAHAM: So we can have celebrities, right, talk about fracking and all sorts of political issues, but we actually have the head of neurosurgery, pediatric neurosurgery, at one of the top hospitals in the world, who gets up on that stage at the National Prayer Breakfast, and he addresses a number of topics, right, but from a common sense, very respectful fashion. He wasn’t mean-spirited. He wasn’t nasty. But the reaction was so profound from the public, thinking, “Why don’t we have politicians who speak in these common sense terms?”

Absurd, but not at all surprising.

Consider the anthropogenic global warming debate.

The media are far more interested in what Al Gore - a man that did terribly in science classes while at Harvard! - and pop star Sheryl Crow have to say on this subject than actual scientists including the over 31,000 that have signed the Oregon Petition.

America's press in 2013 aren't interested in facts or a serious discussion on issues facing the nation.

Instead, the modus operandi is to fill the airwaves and print with nonsensical propaganda while demonizing anyone that deigns to disagree with it.

As Dr. Carson said Monday, "An uneducated populace will fall for anything" including "pundits on television."

(HT Mediaite)


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Insurers See Way To Dodge Federal Healthcare Law Next Year

A new fight is brewing over health insurance companies letting millions of Americans renew their current coverage for another year — and thereby avoid changes under the federal healthcare law.

That may offer a short-term benefit for certain consumers and shield some of those individual policyholders from potentially steep rate increases. But critics say this maneuver could undermine government efforts to remake the insurance market next year and keep premiums affordable overall.

At issue is a little-known loophole in President Obama's landmark legislation that enables health insurers to extend existing policies for nearly all of 2014. This runs contrary to the widespread belief that all health insurance must immediately comply with new federal rules starting Jan. 1, when most provisions of the law take effect.

"Insurers are onto this, and the big question is how many will try to game the system," said Timothy Stoltzfus Jost, a law professor and health policy expert at Washington and Lee University.

Some of the nation's biggest health insurers are looking to take advantage of this delay, and Arkansas officials are encouraging companies to do this by resetting customers' renewal dates for the end of December. There's also concern that some insurers and agents could rush to sell more individual policies before year-end so they could be extended in 2014.

Some policy experts are expressing concern about this practice for fear that insurers will focus on renewing younger and healthier policyholders and hold them out of the broader insurance pool next year. Their absence could leave a sicker and older population in new government insurance exchanges, driving up medical costs and premiums there.

"This could undermine the Affordable Care Act, and it opens the door for exacerbating potential rate shock in the exchanges," said Christine Monahan, a senior analyst at Georgetown University's Health Policy Institute. "The health insurers can cherry-pick some healthy people and it raises prices for everyone else."

This issue could affect some of the 15 million people nationwide who purchase their own coverage and millions more of the uninsured who are expected to join government exchanges next year. It would not pertain to the 150 million Americans who get health benefits through their employers.

Many health insurers are still mulling over their options on how to handle these individual renewals.

"Some carriers will require everyone to switch plans Jan. 1, and other carriers will allow customers to stay on their existing plan as long as possible," said Bob Hurley, senior vice president of carrier relations at online site eHealthInsurance. "We are trying to nail this down with the carriers. I think it would be better for consumers to have that choice to carry their policy forward."

The nation's largest health insurer, UnitedHealth Group Inc. of Minnetonka, Minn., said, "We are currently looking at the best way to serve our customers' best interests while continuing to comply with the Affordable Care Act going into 2014."

WellPoint Inc., the Indianapolis insurance giant that runs Blue Cross plans in California and 13 other states, said its renewal practices will vary by state. In California, the company said its Anthem Blue Cross unit may allow individual policyholders to renew through March 31.

Kaiser Permanente, a major nonprofit health plan based in Oakland, said it doesn't plan to renew policies beyond Jan. 1 in California and most of the other states where it sells coverage.

Richard Kern and his wife, a retired couple in Los Angeles, say they would welcome the flexibility to keep their individual policy from Aetna Inc. for another year amid so much uncertainty over next year's rates.

"We don't even know what the prices and alternatives are under Obamacare," Kern said. "We are waiting for the other shoe to drop."

If an insurer offers this option, it would then be up to consumers to decide whether they want to renew an existing policy into 2014. The length of any renewal may depend on what month their annual plan year begins.

Many lower-income people will qualify for federal premium subsidies, which will be available only when purchasing new coverage available in state- or federal-run insurance exchanges. It would make financial sense to take advantage of that government aid. Individuals earning less than $46,000 or families below $94,000 annually would be eligible for subsidies.

However, many people who are middle income or above could face significantly higher premiums next year with no subsidies. Those premium increases are tied to federal requirements that insurers accept all applicants regardless of their medical condition and the inclusion of more comprehensive benefits.

Renewing an older policy could mean forgoing some of those richer benefits and new limits on out-of-pocket medical expenses.

Last week, California officials estimated that premiums may rise 30% on average for about 1.3 million existing policyholders primarily because of those changes in the federal law. Insurers have warned that some customers could see their premiums double depending on their age and other factors.

Citing that threat of higher rates, Arkansas officials issued a bulletin to insurers last month describing how they could extend individual policies until Dec. 30, 2013, and then renew them for another year.

These health plans "would not be required to comply with the [Affordable Care Act] market reforms until 12/31/2014," according to the Arkansas bulletin.

"For those folks who don't qualify for subsidies, this is a consumer-friendly thing because the premium rates for 2014 will be substantially higher," said Dan Honey, deputy commissioner of compliance for the Arkansas Insurance Department. "You will be exposed to rate shock."

Other states may oppose that approach, further underscoring the uneven implementation of the federal healthcare law across the country. Oregon Insurance Commissioner Louis Savage said these renewals could be problematic and his office issued a rule barring any extension beyond March 31, 2014.

"We want to get as many people as possible into the exchange," Savage said. "I think having renewals go deep into 2014 is counterproductive to the goals of the federal healthcare law."

In California, state lawmakers are working on legislation that could address this renewal issue and other details about how individual policies comply with the federal overhaul.

These questions over renewals are separate from "grandfathered" health policies that existed before the federal law passed in March 2010. Those plans don't have to meet all the requirements of the healthcare law as long as insurers or employers don't make significant changes to them.

chad.terhune@latimes.com


View the original article here

Sunday, July 28, 2013

How Obamacare Will Distort the Health-Care Market

President Barack Obama and his fellow Democrats sold many Americans on the Affordable Care Act largely by emphasizing two arguments: The law would help to reduce overall health-care costs, and it would provide health insurance to those who, for financial or health reasons, cannot get it now.

Unfortunately, both of these arguments are flawed. The law creates market distortions that will significantly raise premiums and costs for many Americans -- including some middle- income families. And there are less costly, less distortionary and less intrusive ways to address the problem of the uninsured.

Two recent independent and nonpartisan studies help to explain how the law fails in its mission.

The first is from the Society of Actuaries, a group representing professionals who measure and manage financial risk. The main conclusion is that individuals and families who purchase their health insurance in the non-group (basically the non-employer-based) market will have to pay higher premiums. This is because the law will increase by 32 percent the costs that insurers must cover for health-care services, the largest driver of health-insurance premiums.

The second study, commissioned by Covered California, the California entity responsible for setting up the state’s health- insurance exchange, speaks directly to premium rates. Isolating the impact that market changes caused by the new federal law will have, the study concludes that premiums for Californians will rise by an average of 14 percent. Increases will be most pronounced for those families who currently have health insurance and are making more than $94,000 or so -- for them, premiums may rise by an average of 30 percent.

What’s the primary reason for these cost increases? In short, it’s the law’s market distortions. Both studies conclude that because the law requires insurers to provide coverage to all comers -- regardless of their pre-existing health status -- the overall pool of those with health insurance will be sicker and more costly to insure.

Public policy sometimes creates market distortions -- as with the minimum wage, for example, or some agricultural subsidies -- and in those cases Americans may believe that the economic costs are outweighed by the societal benefit. But we should make these judgments with our eyes wide open.

In the case of health-care reform, there are less expensive and intrusive ways to help cover the uninsured. We can accomplish many of the Affordable Care Act’s stated goals while still addressing the shortcomings of our health-care system.

Arguably the most significant problem that the law tries to solve with its massive regulatory edifice is that of the patient with a pre-existing medical condition who is either denied coverage altogether or charged a prohibitively high premium. These are people who generally face hurdles in the transition from employer-based coverage to individually purchased insurance, or who are changing plans in the individual market. It’s a problem that affects as many as 4 million Americans, and it’s one that policy makers ought to solve.

The law addresses these concerns primarily through two regulations: as noted earlier, a requirement that insurers provide coverage to anyone who applies, and a prohibition on any variance in premium due to health status. Unfortunately, these rules create the very market distortions that raise consumer costs.

There is another way to solve this problem. State-based, high-risk health-insurance pools can be an effective way of getting those with pre-existing conditions (and therefore high health-care costs) access to affordable health insurance.

High-risk pools generally offer a choice of insurance plans, and enrollment in them is limited to those unable to get or afford other coverage. Premiums are capped, and the additional cost of coverage is paid through a variety of sources, such as assessments on insurers or tax revenue. Because high-risk pools are isolated from the broader health-insurance marketplace, they don’t increase premiums for those outside the pool.

The challenge with high-risk pools is that they must be properly funded and designed. As the fiscal condition of states has worsened over the past few years, funding for high-risk pools has become even more limited. Three years ago, two conservative scholars estimated that a “comprehensive set of high-risk pool programs” would cost $15 billion to $20 billion per year. That is a small fraction of the new spending the Affordable Care Act creates.

The federal government should ensure that state-based, high-risk pools are properly funded, perhaps in the form of block grants to states, which should be regularly reviewed to ensure adequacy. And states should have rules to prevent both insurers and individuals from improperly taking advantage of the high-risk pools.

Solutions such as these are far preferable to the Affordable Care Act’s one-size-fits-all approach. Rather than distort the health-insurance marketplace in a way that will increase costs for many Americans, we should focus on reforms that use market forces to reduce costs. Americans should know that there are better ways to bring about health-care reform.

(Lanhee Chen is a Bloomberg View columnist and a research fellow at the Hoover Institution at Stanford University. He was the policy director of Mitt Romney’s 2012 presidential campaign. The opinions expressed are his own.)

To contact the writer of this article: Lanhee Chen at lchen301 @bloomberg.net or @lanheechen on Twitter.

To contact the editor responsible for this article: Michael Newman at mnewman43@bloomberg.net

Lanhee Chen

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Friday, July 26, 2013

Kooky Paul Krugman Calls for 'Death Panels' to Cut Health-Care Costs -- Really!

Last week New York Times economics columnist and liberal hero Paul Krugman actually said "death panels," the critique of Obama-care popularized by Sarah Palin and universally mocked by liberals, while discussing the necessity of cutting health care costs.

On January 30, Krugman spoke at the Sixth & I Historic Synagogue in D.C. (Krugman is out hawking the paperback edition of "End This Depression Now!," his paean to more government spending on infrastructure and other forms of stimulus.) During the Q&A, Breitbart's Joel Griffith noted, Krugman was asked about the rising national debt. A truncated version of his remarks follows:

We’re going to need more revenue, we're going to need, and probably in the end, surely in the end it will require some sort of middle class taxes as well. So again, we won’t be able to pay for the kind of government the society we want without some increase in taxes, not a huge one, but some increase on taxes on the middle class, maybe a value-added tax.... And we’re also going to do, really, we're going to have to make decisions about health care, not pay for health care that has no demonstrated medical benefits. So you know the snarky version I use, which is, I shouldn’t even say because it will get me in trouble, is death panels and sales taxes is how we do this."

This opens Krugman up to charges of hypocrisy, since he called the "death panel" accusation a "smear" in a March 22, 2010 column and an example of the "dishonesty" of Obama-care opponents in a June 29, 2012 column. Does this mean Krugman accepts Sarah Palin's argument that Obama-care's cost containment strategy will require health-care rationing?

Clay Waters is the director of Times Watch, an MRC project tracking the New York Times. Click here to follow Clay Waters on Twitter.

View the original article here

Monday, July 22, 2013

Insurers See Way To Dodge Federal Healthcare Law Next Year

A new fight is brewing over health insurance companies letting millions of Americans renew their current coverage for another year — and thereby avoid changes under the federal healthcare law.

That may offer a short-term benefit for certain consumers and shield some of those individual policyholders from potentially steep rate increases. But critics say this maneuver could undermine government efforts to remake the insurance market next year and keep premiums affordable overall.

At issue is a little-known loophole in President Obama's landmark legislation that enables health insurers to extend existing policies for nearly all of 2014. This runs contrary to the widespread belief that all health insurance must immediately comply with new federal rules starting Jan. 1, when most provisions of the law take effect.

"Insurers are onto this, and the big question is how many will try to game the system," said Timothy Stoltzfus Jost, a law professor and health policy expert at Washington and Lee University.

Some of the nation's biggest health insurers are looking to take advantage of this delay, and Arkansas officials are encouraging companies to do this by resetting customers' renewal dates for the end of December. There's also concern that some insurers and agents could rush to sell more individual policies before year-end so they could be extended in 2014.

Some policy experts are expressing concern about this practice for fear that insurers will focus on renewing younger and healthier policyholders and hold them out of the broader insurance pool next year. Their absence could leave a sicker and older population in new government insurance exchanges, driving up medical costs and premiums there.

"This could undermine the Affordable Care Act, and it opens the door for exacerbating potential rate shock in the exchanges," said Christine Monahan, a senior analyst at Georgetown University's Health Policy Institute. "The health insurers can cherry-pick some healthy people and it raises prices for everyone else."

This issue could affect some of the 15 million people nationwide who purchase their own coverage and millions more of the uninsured who are expected to join government exchanges next year. It would not pertain to the 150 million Americans who get health benefits through their employers.

Many health insurers are still mulling over their options on how to handle these individual renewals.

"Some carriers will require everyone to switch plans Jan. 1, and other carriers will allow customers to stay on their existing plan as long as possible," said Bob Hurley, senior vice president of carrier relations at online site eHealthInsurance. "We are trying to nail this down with the carriers. I think it would be better for consumers to have that choice to carry their policy forward."

The nation's largest health insurer, UnitedHealth Group Inc. of Minnetonka, Minn., said, "We are currently looking at the best way to serve our customers' best interests while continuing to comply with the Affordable Care Act going into 2014."

WellPoint Inc., the Indianapolis insurance giant that runs Blue Cross plans in California and 13 other states, said its renewal practices will vary by state. In California, the company said its Anthem Blue Cross unit may allow individual policyholders to renew through March 31.

Kaiser Permanente, a major nonprofit health plan based in Oakland, said it doesn't plan to renew policies beyond Jan. 1 in California and most of the other states where it sells coverage.

Richard Kern and his wife, a retired couple in Los Angeles, say they would welcome the flexibility to keep their individual policy from Aetna Inc. for another year amid so much uncertainty over next year's rates.

"We don't even know what the prices and alternatives are under Obamacare," Kern said. "We are waiting for the other shoe to drop."

If an insurer offers this option, it would then be up to consumers to decide whether they want to renew an existing policy into 2014. The length of any renewal may depend on what month their annual plan year begins.

Many lower-income people will qualify for federal premium subsidies, which will be available only when purchasing new coverage available in state- or federal-run insurance exchanges. It would make financial sense to take advantage of that government aid. Individuals earning less than $46,000 or families below $94,000 annually would be eligible for subsidies.

However, many people who are middle income or above could face significantly higher premiums next year with no subsidies. Those premium increases are tied to federal requirements that insurers accept all applicants regardless of their medical condition and the inclusion of more comprehensive benefits.

Renewing an older policy could mean forgoing some of those richer benefits and new limits on out-of-pocket medical expenses.

Last week, California officials estimated that premiums may rise 30% on average for about 1.3 million existing policyholders primarily because of those changes in the federal law. Insurers have warned that some customers could see their premiums double depending on their age and other factors.

Citing that threat of higher rates, Arkansas officials issued a bulletin to insurers last month describing how they could extend individual policies until Dec. 30, 2013, and then renew them for another year.

These health plans "would not be required to comply with the [Affordable Care Act] market reforms until 12/31/2014," according to the Arkansas bulletin.

"For those folks who don't qualify for subsidies, this is a consumer-friendly thing because the premium rates for 2014 will be substantially higher," said Dan Honey, deputy commissioner of compliance for the Arkansas Insurance Department. "You will be exposed to rate shock."

Other states may oppose that approach, further underscoring the uneven implementation of the federal healthcare law across the country. Oregon Insurance Commissioner Louis Savage said these renewals could be problematic and his office issued a rule barring any extension beyond March 31, 2014.

"We want to get as many people as possible into the exchange," Savage said. "I think having renewals go deep into 2014 is counterproductive to the goals of the federal healthcare law."

In California, state lawmakers are working on legislation that could address this renewal issue and other details about how individual policies comply with the federal overhaul.

These questions over renewals are separate from "grandfathered" health policies that existed before the federal law passed in March 2010. Those plans don't have to meet all the requirements of the healthcare law as long as insurers or employers don't make significant changes to them.

chad.terhune@latimes.com


View the original article here

Friday, July 19, 2013

Talking Numbers: Buy Humana or United Healthcare?

 Highlight transcript below to create clipTranscript:  Print  |  Email Go  Click text to jump within videoTue 02 Apr 13 | 03:30 PM ET Which health insurance stock can keep your portfolio strong? Enis Taner, RiskReversal.com and Zachary Karabell, River Twice Research, discuss.

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Saturday, June 22, 2013

Agency: IRS Failed To Tally Paperwork Burden From Healthcare Mandate

By Megan R. Wilson - 03/18/13 02:42 PM ET

The federal government’s small-business advocate is taking aim at the healthcare reform law’s insurance mandates.

The Office of Advocacy, an independent agency within the Small Business Administration, is calling out the Internal Revenue Service (IRS) for failing to conduct a regulatory flexibility analysis in the crafting of the rules. The analysis is required under a 32-year-old law called the Regulatory Flexibility Act, which requires that agencies spell out how their regulation will impact small businesses in both hours and dollars.

That requirement, which was strengthened by the Small Business Regulatory Enforcement Fairness Act (SBREFA) of 1995, has not been followed in the rule-making process for the mandate for employers to provide insurance, according to Winslow Sargeant, the chief counsel for the advocacy office.

The IRS said it did not need to go through that assessment because only large employers — defined as businesses that employ 50 or more people — are required under the healthcare law to either provide workers with health insurance or pay a fine.

But Sargeant and his assistant chief counsel, Dillon Taylor, said the act of a small business assessing whether or not it should comply with the regulation — and the paperwork it must keep in case it does — impose a heavy burden.

The IRS, they argue, must analyze the paperwork burden from the rule and then put those findings forward in the Federal Register for comment. That would give small businesses “adequate data to assess the amount of paperwork burden that may be generated by the proposed rule,” the Office argues, and provide the IRS with “valuable insight into the effects of the [proposal].”

Monday was the deadline to comment on the bevy of regulations that will implement the insurance mandate. By mid-day, those rules had only received 223 comments on the Regulations.gov website. The IRS’s review of those comments will begin on Tuesday.

The stakes are high for the mandate – and a retroactive analysis could push back the implementation even further. If the IRS does not listen to the call for the data analysis, it could face a lawsuit that would force it to back to the drawing board to run the numbers.

The Office of Advocacy has come under fire from watchdog groups who say it works to kill regulations.

In January, the Center for Effective Government and the Center for Progressive Reform alleged that the SBA Office is a mouthpiece for industry lobbyists who want regulations shut down — an accusation that Sargeant has since denied.

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Friday, June 21, 2013

Health-Care Law Uncertainty Grips Old Town Alexandria Cafe — And Other Small Businesses

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Going Out Guide | Lavanya RamanathanJobsIn Jobs#header-v3 #main-nav li.realestate{display:none;}#header-v3 #main-nav li a.top, #header-v3 #main-nav li a.top:link, #header-v3 #main-nav li a.top:visited, #header-v3 #main-nav li a.top:hover {font-size:13px;padding: 0 4px 0 5px !important;}#header-v3 #main-nav li a.home, #header-v3 #main-nav li a.home:link, #header-v3 #main-nav li a.home:visited, #header-v3 #main-nav li a.home:hover {padding: 0px !important;}#header-v3 #main-nav li.politics {border-left:none;}#header-v3 #main-nav li.classifieds {border-right:none;}#header-v3 #main-nav-wrapper-v2 .classifieds .rollMe {right:-1px;height:140px;width:260px;}#header-v3 #main-nav li.politics:hover {-moz-box-shadow: none;-webkit-box-shadow: none;box-shadow: none;}MoreClassifiedsCarsDealsReal EstateRentalsPhotosShoppingObituariesArchivesTopicsBlogsOn Small Business In the NewsNCAA scores Quantico shootings Chinua Achebe dies BlackBerry Z10 Yoga pants body .ui-menu-item { margin: 4px 0; text-align: left; text-indent: 10px;}body .ui-autocomplete.ui-widget-content{ border-top: medium none; border-top-left-radius: 0; border-top-right-radius: 0; display: block; left: 154px; position: absolute; width: 199px; z-index: 1;}body .ui-widget-content a { background-image: none !important; border: medium none !important; border-radius: 0 0 0 0; color: #222222; cursor: pointer; display: block; line-height: 1.8em; margin: 0; padding: 0; width: 100%;}.search input{ width: 200px;}???initialComments:true! pubdate:03/20/2013 21:08 EDT! commentPeriod:14! commentEndDate:4/3/13 9:8 EDT! currentDate:3/21/13 8:0 EDT! allowComments:true! displayComments:true!Health-care law uncertainty grips Old Town Alexandria cafe — and other small businesses(Evy Mages/ FOR THE WASHINGTON POST ) - Jody Manor wants to open a second location of Bittersweet Catering, Cafe and Bakery, but health care costs could derail those plans.

(Evy Mages/ FOR THE WASHINGTON POST ) - Jody Manor wants to open a second location of Bittersweet Catering, Cafe and Bakery, but health care costs could derail those plans.

(Evy Mages/ FOR THE WASHINGTON POST ) - Jody Manor wants to open a second location of Bittersweet Catering, Cafe and Bakery, but health care costs could derail those plans.(Evy Mages/ FOR THE WASHINGTON POST ) - Jody Manor has owned the cafe for about 30 years and has close to 50 employees. He is an example of a small business faced with new healthcare regulations.CAPTIONFULLSCREEN By , Mar 21, 2013 01:08 AM EDT

The Washington Post

Jody Manor has run a small cafe and catering company for nearly three decades in Old Town Alexandria, only a few blocks from where he was born. Six years ago he purchased an adjoining building, and more recently he started searching for a second location.

Whether he moves forward with expansion depends on the price tag of the requirements mandated by the Affordable Care Act, President Obama’s signature health-care initiative.

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Manor’s company employs 45 people. If he brings in just five more, his business would soon be subject to new minimum coverage standards under the 2010 law — and he does not know whether his current health plan would meet this threshold of coverage or how his premiums might be affected.

“These changes are less than a year away, and I still have no information about how much our premiums are going to cost,” said Manor, owner of Bittersweet Catering, Cafe and Bakery. “It definitely gives me pause when thinking about adding another location.”

Nearly three years after the health-care law was passed, federal regulators have only recently begun to define its terms. Major pieces of the overhaul, such as state-run exchanges that will serve as marketplaces for qualified health insurance plans, have yet to take shape, and several rules remain unwritten. Consequently, the picture remains anything but clear for small-business owners, some of whom have been warned that their premiums may spike and that their current coverage may fall short.

“There is tremendous confusion and fear among many of my competitors and other business owners in my network, particularly about what you have to cover and how you have to report,” said Hugh Joyce, owner of James River Air Conditioning in Richmond. “In speaking to them, I am convinced that the primary reason we aren’t seeing a robust economic recovery is the uncertainty and costs associated with this health-care law.”

Others are not so critical. They argue that the measures promise to rein in soaring health-care costs and provide a safety net to small businesses and employees, many of whom would be able to buy insurance through the exchanges.

The Department of Health and Human Services three weeks ago issued a final set of regulations on the minimum value for health insurance packages, mandating that plans cover at least 60 percent of health expenses and 10 primary areas of care, including maternity, ambulance and prescription services.

Joyce, whose company employs 150 people, provides what his insurers tell him will “probably qualify” as adequate coverage under the new rules, but he isn’t certain.

If his current plan falls short, experts say he won’t be alone in deciding whether to find a suitable alternative or pay a penalty.

The minimum-benefit plan mandated by the law “is broader than what’s currently offered by a lot of small businesses,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade group for providers.

Zirkelbach warned that even firms that already offer sufficient coverage may see their premiums surge under the health-care law. New rules that restrict how insurers can structure their rates could drive prices higher across the board, he said, while small firms could be hit indirectly by a new fee on insurance providers, which some fear will be passed along to individuals and small employers in the form of higher premiums.

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