Why States Are Struggling to Build on the Affordable Care Act

Despite plenty of 2018 campaign promises to build on the Affordable Care Act at the state level, not a whole lot has been done since the start of 2019. There are no new federal regulations or legislative efforts likely to impact health insurance this year, either. Things seem to have reached a standstill for now.

So what is the issue? How could so many candidates win on the healthcare issue without any real action taking place four months into the new year? According to Politico contributors Rachana Pradhan and Dan Goldberg, the two biggest issues are cost and public opinion. Neither are surprising to people who have a finger on the pulse of the healthcare issue.

 

The Problem of Cost

A number of candidates running for state office in Nevada, New Mexico, and a few other blue states ran on promises of covering more people with government-backed health insurance. Some of the candidates even laid out plans for universal health care. None of those plans have materialized as of yet. Why? Primarily because of cost.

It is easy to campaign on increasing health insurance coverage. When it comes time to implementing that coverage though, it has to be paid for. And unfortunately, most state budgets just cannot support new healthcare measures. We are running huge deficits at both the state and federal levels as a matter of course. And that leads us to the second issue of public opinion.

 

The Problem of Public Opinion

An easy solution to the cost issue is to raise taxes. But guess what? Taxpayers hate tax increases. Universal healthcare seems like a great idea as long as it is free. But nothing ever is. Universal healthcare has to be paid for by someone, and the rich simply do not make enough money to shoulder the burden. So in order to increase healthcare coverage at either the state or federal level, government has no choice but to increase taxes on everyone.

Candidates who won office in 2018 based on promises to increase healthcare coverage know full well that turning around and proposing tax hikes could very easily doom their chances for re-election. There are only a small number of politicians willing to take that chance, and they don't have enough support among their peers to make it happen.

 

Where We Go from Here

Knowing what we know, the question is one of where we go from here. It turns out there is no place to go. There are no legislative or regulatory efforts underway that stand to have any impact on health insurance for the remainder of this year and into 2020.

A number of Democrat 2020 hopefuls are floating universal healthcare solutions that could be an issue a few years from now. Some are championing Bernie Sanders' Medicare For All plan while others are coming up with their own proposals.

On the other side of the aisle, Republicans are crafting a new healthcare proposal with the expectation that a Texas court will confirm its previous decision invalidating the entire ACA now that the individual mandate has been eliminated. Republicans aren't offering any details as of yet. They probably won't until, and unless, the court rules in their favor.

As an employer, this means that the ACA is still the law of the land in every respect except the individual mandate. Your obligations have not changed for this tax year. They aren't likely to change for the 2020 tax year either. So make sure all of your ducks are in a row. ACA compliance is still a legal requirement, not an option.

 

Sources:

Politico – https://www.politico.com/story/2019/04/08/health-care-blue-states-1308730