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For Better or Worse, It Is the Law

Fri, Aug 23rd, 2013
Posted in All Commentary

By Karen Reisner

Sifting through all the over the top rhetoric makes it hard for us to determine the potential long lasting effect the Patient Protection and Affordable Care Act (PPACA), commonly referred to a Obamacare, will have on us as health care consumers and the American economy. Most of the bombastic spin comes from those strongly in support of the law or those strongly against. It would be nice to get just the facts and realistic projections. For sure, no one really knows the long term effect at this point.

The ‘tea party’ people want to shut down the federal government in an effort to defund the implementation of PPACA. Senate Minority Leader Mitch McConnell (R) recently said while speaking at a political event in Kentucky that he was in favor of stopping Obamacare, “but shutting down the government will not stop Obamacare.”

Within the PPACA there are provisions to fund much of its implementation, so implementation is not dependent solely on congressional appropriations to fund it. However, shutting down the government will have significant impacts on various services and functions including but not limited to military pay checks, business and housing loans, National Parks, museums, national forests, and customer services at the IRS. Government services considered essential would not be interrupted.

The continuing resolution to keep the federal government up and running must be passed before October 1, which is also the date the health insurance exchanges are scheduled to begin.

Speaker John Boehner in a November 2012 ABC interview said, “Obamacare is the law of the land.” However, useless and repeated efforts to repeal the law have continued. The House Republican majority has passed a bill to repeal PPACA or some part of it 40 times, which serves no other purpose than scoring political points with their base. Members can go home and report to their constituents that they have continually voted to repeal the law.

Republicans object to the health insurance mandates, the cost of health insurance subsidies, and the implementation of another large social program. However, I do not hear similar objections to the cost of subsidizing large oil companies or corporate agriculture. Subsidies are spending regardless of the recipient. It is a well known that once a social program is implemented, it quickly becomes very difficult politically to step it back.

Only in a seriously dysfunctional Washington can Congress fail to agree on a Farm Bill, an Immigration Law, and long term structural changes necessary to sustain mandatory entitlement programs, while continuing to power through a bill in the House over and over which is essentially dead before it is voted on. There are important issues that must be dealt with. These issues if settled in new law can build business confidence, which will drive economic growth and likely produce jobs. Congress only seems to be able to move forward when they are forced into a last minute compromise brought on by a fiscal deadline like raising the debt limit. Stay tuned, the debt limit showdown will unfold in October.

Due to the June 28 United States Supreme Court ruling that allowed the PPACA law to stand mostly intact, plus a Democratic majority in the Senate and a reelected President Obama, it is time to accept the fact that the PPACA will be implemented. The high court rejected a portion of the law that would cut funding to states that refused to comply with expanded eligibility requirements for Medicaid. In the light of these political realities in Washington, it makes more sense to gear efforts toward fixing and improving the law, but “common sense” is a rare commodity today in Washington. Compromise and common sense have fallen victim to extreme ideology obsessions and self-aggrandizement.

No doubt, PPACA will be more of a challenge and costly to implement than past social programs. The road to implementation will certainly be bumpy. Conflicting information confuses all of us and it is difficult to really know what affect it will have on our medical care and the out of pocket expenses for that care. It seems likely that some of us will pay more for insurance coverage, some less, and probably most will not see much of a difference. If all goes well, millions of Americans will be insured as of January 1, 2014 that are not currently. The administration has delayed the institution of a penalty for one year if businesses with 50 or more employees fail to provide health insurance for their employees. A year delay has also been made for a mandated cap on out of pocket expenses for consumers (only affects employer plans). These delays are intended to allow employers additional time to get into compliance.

PPACA intends to increase competition to help keep health care costs under control. The health care industry needs to produce quality rather than quantity of care.

Who really knows where this health care law will take us. One thing for sure, Congress has to be willing to reshape the law to fit changing demographics over time. This structural reshaping process is necessary soon for Medicare and Social Security to sustain the programs with the retirement of the baby boomers.

For some this health care law will greatly improve the quality of their lives and may save many lives. Those that have good employer provided health insurance now will likely not notice much difference. Several years down the road, we will know the real pluses and minuses of this law. If we had a working Congress with some flexibility and the ability to look ahead, weaknesses and shortcomings in the law could be identified over time and changes could be made to improve the law. This futile resistance to what is the law of the land today only will cost all of us. It will not change what is and will be until at least 2017.


Federal grant money has been sent to states that are setting up state-level health exchanges. Minnesota has received $110 million. Nearly 10 percent of Minnesota residents don’t have health insurance. Over 1 million people within Minnesota are expected to use the government run exchange called MNsure.

Federal financial assistance will be provided for those with incomes that are under 400 percent of the poverty level. Those under 138 percent will qualify for Medicaid. MNsure enrollment starts in October.

MNsure will provide the opportunity to compare plans online. It will let you know if you qualify for financial assistance. For more information about MNsure visit

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