Skip to main content

Obamacare delay: Business wins, the rest of us lose

By Ford Vox, Special to CNN
updated 4:30 PM EDT, Sun July 7, 2013
President Barack Obama is applauded after signing the Affordable Care Act at the White House in 2010.
President Barack Obama is applauded after signing the Affordable Care Act at the White House in 2010.
STORY HIGHLIGHTS
  • Ford Vox says the new delay in employer mandate has made him lose faith in Obama's wisdom
  • He says businesses lobbied for delay, but the poorly insured and taxpayers pay the price
  • He says move delays penalties, protects profits, for businesses that don't meet ACA regulations
  • Vox: Mortally wounding Obamacare before midterm elections helps its opponents

Editor's note: Ford Vox, a brain injury physician at the Shepherd Center in Atlanta, writes widely on medicine and health care policy. Follow him on Twitter.

(CNN) -- As a rehabilitation physician, I've supported many of the ideas behind the Affordable Care Act since before Barack Obama's presidency began. During the hot summer of town hall debates surrounding the legislation in 2009, I wrote an essay called "Standing up for Obama's health plan," and I have continued highlighting the fundamental advances that all of us, most especially disabled Americans, stand to share under the ACA.

But when the Obama administration decided last week to pull out a major pillar of the ACA, they lost my faith in their political wisdom.

There was a practical necessity to many of the president's other compromises in order to get the ACA passed. Regrettably, it gives states just enough power over insurance marketplaces and the Medicaid expansion to continue the unequal and unfair distribution of state-based social services. It allows states to eviscerate Medicaid in ways that don't make sense.

In some states, Medicaid pays to save the life of a stroke victim in the hospital, but then denies adequate rehabilitation services and devices to prevent that person's ongoing health problems from rapidly placing further strain on the thin social-service safety net.

Ford Vox
Ford Vox

The vast majority of Americans get medical insurance through their employers, although the number of employers that offer insurance has fallen 10% since 2000, and the insurance they do offer is increasingly lousy. Low-quality insurance, like so-called "mini medical" plans, is common. Employees won't know their coverage is insufficient until it's too late. If you work for one of these companies and your child suffers a serious trauma, the 30 visits or fewer these plans offer for outpatient therapy simply won't be enough. I've seen this gut-wrenching situation time and again.

True health care reform must end this sorry state of affairs in the workplace, where health care is centered. But by postponing for a year the implementation of the ACA's requirement that employers with more than 50 full-time workers offer insurance of minimally acceptable quality or face fines of $2,000 to $3,000, the administration has weakened the core of health care reform. It is delaying a critical national debate on what the ACA minimums should be.

How did this happen? The administration caved to pressure from business lobbyists, who, according to Politico, "mounted a coordinated campaign to convince senior White House officials that their date for requiring coverage was simply impractical." It's too bad patients and health care providers didn't get their counterbalancing message out. Without it, the business lobby was able to create an atmosphere of false urgency by claiming businesses weren't ready to start filing the information about the insurance plans they offer (or don't).

Without that critical information, the rest of the already heavily compromised ACA apparatus starts to tilt precariously. How can the government enforce the individual mandate, which requires people to buy insurance if their employers don't offer it or if they offer insurance that is substandard or overpriced? Without information from businesses, the government won't know whether individuals are claiming legitimate exemptions or not.

Obamacare requirement is delayed
Free breast pumps under Obamacare
Obamacare 37, Republicans 0

The federal government has long excelled at helping private businesses attract and retain workers with affordable benefits. American business lobbyists don't gripe so much about the nearly $200 billion in tax credits the nation grants their clients by designating employer-offered health benefits nontaxable. You'd think businesses would be pleased that the Congressional Budget Office projects that businesses that don't offer qualifying insurance plans will be paying only $10 billion in penalties in 2014. Now they'll be paying zilch.

In its notice announcing the ACA delay, the administration correctly states that the vast majority of employers already provide insurance. But so what? The ACA is as much about regulating insurance as encouraging businesses to provide it.

America's employers, left to their own devices, have been exchanging dinky medical insurance for cheaper products and services for too long. Peachtree Hotel Group, which owns a variety of chain hotels, mostly in the South, recently disclosed to The Wall Street Journal how much it nickle-and-dimes the health of its 550 employees. The company's chief financial officer says it offers a limited benefit plan, and now that the ACA is delayed for a year, it may increase the employee contribution on the full-benefit plan it was planning to offer next year under the law.

The next time you stay at Peachtree's Courtyard by Marriott in Gulf Shores, Alabama, know that you could be paying a few cents less for your room so that Peachtree can provide capped health coverage to its valued employees. But if a Peachtree employee were to suffer a catastrophic injury, every taxpaying citizen of Alabama would be paying a few cents more to provide the Medicaid coverage and social services the patient needs.

Why does it make sense to let companies make irresponsible choices in exchange for a little more profit? These are the kinds of cutthroat business decisions a massive piece of legislation like the ACA should combat.

The retail and restaurant lobbyists who stealthily hunted bigger profit margins these past few months will now seize on the act's wounded carcass. Republicans are already charging that this delay proves the administration knows the ACA is unworkable. They're using this decision as another opportunity to stop or delay the law.

They're right to do so. The ACA represents a large, painful change for a number of American institutions. Hospitals, doctors, patients, insurers and our government are in for a period of turmoil as these changes pulse through society's many layers. Handing a reprieve to one of those groups is unfair to the rest of us, and will distort the necessary debates as specific problems come to light just in time for the 2014 midterm elections.

The administration should either delay the whole law until 2015 or go forward in 2014 as planned. Mortally wounding the ACA before the coming battle isn't compromise -- it's foreshadowing.

Follow @CNNOpinion on Twitter.

Join us at Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Ford Vox.

ADVERTISEMENT
Part of complete coverage on
updated 11:16 AM EDT, Thu August 28, 2014
Whitney Barkley says many for-profit colleges deceive students, charge exorbitant tuitions and make false promises
updated 10:34 AM EDT, Fri August 29, 2014
Mark O'Mara says the time has come to decide whether we really want police empowered to shoot those they believe are 'fleeing felons'
updated 10:32 AM EDT, Thu August 28, 2014
Bill Frelick says a tool of rights workers is 'naming and shaming,' ensuring accountability for human rights crimes in conflicts. But what if wrongdoers know no shame?
updated 10:43 PM EDT, Thu August 28, 2014
Jay Parini says, no, a little girl shouldn't fire an Uzi, but none of should have easy access to guns: The Second Amendment was not written to give us such a 'right,' no matter what the NRA says
updated 9:40 AM EDT, Thu August 28, 2014
Terra Ziporyn Snider says many adolescents suffer chronic sleep deprivation, which can indeed lead to safety problems. Would starting school an hour later be so wrong?
updated 9:30 AM EDT, Fri August 29, 2014
Peggy Drexler says after all the celebrity divorces, it's tempting to ask the question. But there are still considerable benefits to getting hitched
updated 2:49 PM EDT, Fri August 29, 2014
The death of Douglas McAuthur McCain, the first American killed fighting for ISIS, highlights the pull of Syria's war for Western jihadists, writes Peter Bergen.
updated 6:42 PM EDT, Tue August 26, 2014
Former ambassador to Syria Robert Ford says the West should be helping moderates in the Syrian armed opposition end the al-Assad regime and form a government to focus on driving ISIS out
updated 9:21 AM EDT, Wed August 27, 2014
Ruben Navarrette says a great country does not deport thousands of vulnerable, unaccompanied minors who fled in fear for their lives
updated 9:19 AM EDT, Wed August 27, 2014
Robert McIntyre says Congress is the culprit for letting Burger King pay lower taxes after merging with Tim Hortons.
updated 7:35 PM EDT, Tue August 26, 2014
Wesley Clark says the U.S. can offer support to its Islamic friends in the region most threatened by ISIS, but it can't fight their war
updated 7:26 AM EDT, Wed August 27, 2014
Jeff Yang says the tech sector's diversity numbers are embarrassing and the big players need to do more.
updated 4:53 PM EDT, Tue August 26, 2014
America's painful struggle with racism has often brought great satisfaction to the country's rivals, critics, and foes. The killing of Michael Brown and its tumultuous aftermath has been a bonanza.
updated 4:19 PM EDT, Tue August 26, 2014
Ed Bark says in this Emmy year, broadcasters CBS, ABC and PBS can all say they matched or exceeded HBO. These days that's no small feat
updated 3:19 PM EDT, Tue August 26, 2014
Rick Martin says the death of Robin Williams brought back memories of his own battle facing down depression as a young man
updated 11:58 AM EDT, Tue August 26, 2014
David Perry asks: What's the best way for police officers to handle people with psychiatric disabilities?
updated 3:50 PM EDT, Mon August 25, 2014
Julian Zelizer says it's not crazy to think Mitt Romney would be able to end up at the top of the GOP ticket in 2016
updated 4:52 PM EDT, Mon August 25, 2014
Roxanne Jones and her girlfriends would cheer from the sidelines for the boys playing Little League. But they really wanted to play. Now Mo'ne Davis shows the world that girls really can throw.
updated 12:29 PM EDT, Mon August 25, 2014
Peter Bergen and Emily Schneider say a YouTube video apparently posted by ISIS seems to show that the group has a surveillance drone, highlighting a new reality: Terrorist groups have technology once only used by states
updated 5:04 PM EDT, Mon August 25, 2014
Kimberly Norwood is a black mom who lives in an affluent neighborhood not far from Ferguson, but she has the same fears for her children as people in that troubled town do
updated 5:45 PM EDT, Fri August 22, 2014
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
updated 1:27 PM EDT, Tue August 26, 2014
John Bare says the Ice Bucket Challenge signals a new kind of activism and peer-to-peer fund-raising.
updated 8:31 AM EDT, Fri August 22, 2014
James Dawes says calling ISIS evil over and over again could very well make it harder to stop them.
updated 9:05 PM EDT, Sat August 23, 2014
As the inquiry into the shooting of Michael Brown continues, critics question the prosecutor's impartiality.
updated 6:47 PM EDT, Fri August 22, 2014
Newt Gingrich says it's troubling that a vicious group like ISIS can recruit so many young men from Britain.
updated 10:50 AM EDT, Thu August 21, 2014
David Weinberger says Twitter and other social networks have been vested with a responsibility, and a trust, they did not ask for.
updated 7:03 AM EDT, Fri August 22, 2014
John Inazu says the slogan "We are Ferguson" is meant to express empathy and solidarity. It's not true: Not all of us live in those circumstances. But we all made them.
updated 8:23 AM EDT, Fri August 22, 2014
Retired Lt. Gen. Mark Hertling says he learned that the territory ISIS wants to control is amazingly complex.
updated 3:51 PM EDT, Wed August 20, 2014
Cerue Garlo says Liberia is desperate for help amid a Ebola outbreak that has touched every aspect of life.
updated 1:42 PM EDT, Thu August 21, 2014
Eric Liu says Republicans who want to restrict voting may win now, but the party will suffer in the long term.
updated 11:38 AM EDT, Thu August 21, 2014
Jay Parini: Jesus, Pope and now researchers agree: Wealth decreases our ability to sympathize with the poor.
updated 8:00 AM EDT, Thu August 21, 2014
Judy Melinek offers a medical examiner's perspective on what happens when police kill people like Michael Brown.
updated 6:03 PM EDT, Tue August 19, 2014
It used to be billy clubs, fire hoses and snarling German shepherds. Now it's armored personnel carriers and flash-bang grenades, writes Kara Dansky.
updated 1:27 PM EDT, Wed August 20, 2014
Maria Haberfeld: People who are unfamiliar with police work can reasonably ask, why was an unarmed man shot so many times, and why was deadly force used at all?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT