Dr. Klauer: So our problem is we still treat health care in this country as a right, but we’re funding it as a privilege, and this law doesn’t change that.
Explore This IssueACEP Now: Vol 33 – No 01 – January 2014
Dr. Cirillo: We treat it as something that we have to do because we have the possibility of doing it. And we stopped being thoughtful and mindful about what we should do.
Dr. Klauer: Todd?
Dr. Taylor: With the Affordable Care Act, we now treat health care as a fundamental right, but we are now funding it as mandate, and I think that’s the difference.
Dr. Klauer: So do you think it’s sustainable, Mike?
Dr. Granovsky: Not sustainable under it’s current form.
Dr. Klauer: Todd?
Dr. Taylor: OK, I have to explain why it’s not sustainable. The idea, under the Affordable Care Act, was to get everybody to contribute into the insurance pool and then spread the risk across the entire pool. The problem is that this scheme does not accomplish that and, in fact, makes it worse.
Dr. Rosenau: I’m like the rest of the population: I have to reserve judgment. I’m not sure. I know that I live by the values that I heard when they first talked about the Affordable Care Act, which was we have 47 million Americans that are uninsured and don’t get proper health care because of that. We’re living in a divergent system where some people get one level of health care and the other one-sixth, the other 47 million, do not. I would like to see a consistent level of health care be provided to all of our citizens, and I think that we have to find a way to do that in an affordable manner.
Dr. Granovsky: Relating to the individual health mandate, it’s actually quite soft. Although the 1 percent or $95 penalty is in place and a very significant step for us societally, the IRS has been stripped of its usual enforcement mechanisms. If any of the folks on this call owe the IRS $95, the IRS has very significant items in its toolkit to collect that, including garnishment of wages, liens on property, freezing of bank accounts. And in fact, those three mechanisms of enforcement, or collection of the $95 penalty, have been removed from the IRS’ processes. The main mechanism for recouping an individual-mandate $95 penalty would be an offset against a future tax refund. It remains to be seen how often folks who fall into that cohort of not purchasing individual insurance would actually have a tax refund that would be available for offsets.