TIME Health Care

The Obamacare Mandate Won’t Pack Much Punch

Arminda Murillo, 54, reads a leaflet at a health insurance enrollment event in Cudahy, Calif., on March 27, 2014.
Arminda Murillo reads an Obamacare leaflet at a health-insurance-enrollment event in Cudahy, Calif., on March 27, 2014 Lucy Nicholson—Reuters

The individual mandate in Obama's health care reform law is beginning to kick in. But exemptions, small fines and difficult enforcement make it more of a mini-mandate for the Affordable Care Act

The Obama administration has been on a publicity blitz ahead of Monday’s deadline to enroll in health insurance under the Affordable Care Act, bracing for a last-minute flood of customers that could spark new technical problems.

Uninsured Americans who do not start the process of signing up for coverage by March 31 may face federal fines under the health care reform law. The so-called individual mandate is one of the most unpopular provisions in the health care law, but it’s also a crucial lever for drawing healthy, young uninsured Americans into the insurance pool to even out the risk of insuring older and sicker enrollees. The Congressional Budget Office recently estimated that delaying the mandate one year would result in 13 million fewer Americans having health insurance by 2018. But even with the mandate in place, weak enforcement mechanisms and a slew of exemptions means the requirement to have health insurance under Obamacare packs less of a punch than many Americans assume.

Here’s how:

The fines start off very small

For 2014, an uninsured adult subject to the individual mandate penalty will have to pay the federal government $95 or one percent of his or her income, whichever is greater. But the fine is prorated to only the time period the person is uninsured. Plus, the only earnings included in the one percent formula are those above the federal income tax filing limit, which was $10,000 in 2013. The mandate penalty increases to $325 or two percent of taxable income in 2015 and $695 or 2.5 percent of taxable income in 2016. “The thinking was that you tap them on the wrist the first year and then it gets bigger,” says Timothy Jost, a law professor at Washington and Lee University and a policy expert on the ACA.

The list of reasons someone could be exempted from the mandate is long

Native Americans, undocumented immigrants, prisoners and those with religious objections to health insurance are exempted from the individual mandate penalty. There are also exemptions based on earning power and affordability. Those who do not earn enough to file income tax returns are exempt. If the lowest priced health plans available through a person’s ACA exchange costs more than eight percent of his or her household income, he or she is exempt. The Department of Health and Human Services (HHS) also says those who experience specific setbacks which indicate financial hardship are exempt. These include being homeless, getting evicted or facing eviction or foreclosure, receiving a shutoff notice from a utility company, being the victim of a natural or man-made disaster like flood or fire, filing for bankruptcy or racking up unaffordable medical expenses or increased costs from caring for an ill, disabled or aging family members. There are also exemptions for victims of domestic violence and those who experience the death of an immediate family.

After the Supreme Court ruled in 2012 that expanding Medicaid, a cornerstone of the ACA’s strategy for increasing insurance coverage, was optional for states, HHS added another exemption. Those who would have been covered by Medicaid if their states had expanded the program are exempt from the mandate and penalty if their state declines. Then last fall, after insurance companies canceled individual private plans that did not comply with the ACA’s new rules and regulation, HHS added a new exemption for people previously covered under those plans. After a nationwide uproar over the cancellations, HHS said that those whose plans were canceled could avoid the mandate and penalty in 2014 if they “believe other Marketplace plans are unaffordable.”

And lastly, HHS added a brand new exemption category in December, after a federal exchange website and some run by states launched in October and were plagued with major technical problems. On a web page explaining individual mandate exemptions, HHS says uninsured Americans who “experienced another hardship in obtaining health insurance” would qualify. While more detail on what constitutes “hardship” in these cases is not available, Jost said it’s likely HHS would require some proof. “It’s not going to be enough to say that I called the [ACA] call center and the line was busy,” he says.

Enforcing the individual mandate won’t be easy

The ACA statute specifically says that an uninsured person not exempted from the mandate cannot be criminally prosecuted or jailed for refusing or failing to pay the fine. The IRS is also barred from placing liens or levies on property in an effort to collect the ACA fine. This means the only way the IRS can force a person to pay an individual mandate penalty is by withholding the penalty amount from a tax refund. This is an effective tool, but only applicable to individuals who are owed a refund. Everyone else just gets a letter from the IRS asking them to pay up.

In addition to the possibility they could be forced to pay individual mandate penalties, there is another reason uninsured Americans may want to sign up for health coverage by March 31. They will not have another opportunity until November when the 2015 open enrollment period begins (those who have a specific life event that affects their coverage—like a marriage or job loss—will be allowed to purchase plans in the interim).

Anticipating a crush of procrastinating uninsured Americans trying to sign up for health insurance at the last minute, HHS announced last week that those who begin, but do not finish, the enrollment process by March 31 will be able to complete their applications after that date. The move was a sign the Obama administration realizes heavy last-minute demand may cause online technical problems with the ACA’s exchanges in the final days of the six-month open enrollment period.

“I would not be amazed if there were problems the last day and I would not be completely amazed if they added an extra day,” Jost says. “But it really wouldn’t make any difference. The main thing is that we finish the open enrollment so insurers can figure out what they’ve got and what their premiums will be in 2015.”

TIME Health Care

Poll: Obamacare Support Hits New Low

One survey says more Americans than ever don't like the health care reform law

Support for the health care reform law is at its lowest point since it was enacted four years ago, according to a new poll.

The Associated Press survey found that only 26 percent of Americans support the Affordable Care Act, President Barack Obama’s signature domestic achievement. Forty-three percent said they are opposed to the law. The poll was conducted online, and online polls are typically not as accurate as telephone polls. But the results nevertheless point to political peril for Democratic congressional candidates in the midterm elections, with Republicans again running against the law across the country.

The results also differ from a recently released Kaiser Family Foundation poll that found support for the Affordable Care Act was at 38 percent, though more Americans had unfavorable views of the law. About 46 percent of Americans surveyed by the Kaiser Family Foundation were opposed to the law in March.

Despite their opposition, the majority of Americans don’t think the law is going anywhere, according to the AP poll. Only 13 percent of those surveyed said they think it will be repealed. About seven in 10, however, believe a bipartisan package of changes to the law will be implemented, though opinions vary on how large or minor the changes will be. Republicans continue to push for wholesale repeal, but the law continues to be implemented, and repeal is an even more distant possibility than it was before. The White House said Thursday that more than six million Americans have signed up for new health insurance through the law’s federal and state insurance exchanges.

Fifty-six percent of those surveyed said there were problems when someone in their household tried to sign up, reflecting the widespread early problems with Healthcare.gov and the other state exchanges, many of which have since been fixed.

The poll of 1,012 American adults was conducted between March 20 and March 24, and has a margin of error of 3.4 percentage points.

[AP]

TIME Domestic Policy

Congress Eyes Crackdown on Sex Trade Customers

While the federal government has taken steps to curb child sex trafficking, lawmakers agree a more aggressive approach is needed on the demand-side of the problem. Texas Rep. Ted Poe said Wednesday that customers of child prostitutes need to be held accountable

More needs to be done to prosecute those who purchase children and teens for sex, lawmakers in both parties agreed Wednesday.

“The kids are not for sale, period,” Texas Republican Rep. Ted Poe said during a meeting of a House Judiciary Committee panel. The hearing, during which Poe decried the “boys being boys” attitude taken when it comes to the men who purchase prostitutes, reflected a growing focus by policy makers on the demand-side of the sex trade.

While state and federal law enforcement officials testified Wednesday about the many ways they’ve altered their approach to victims over the years, none could give concrete answers to questions about how “johns” who purchase sex are prosecuted. Corporal Chris Heid of the Maryland state police’s child recovery unit testified that the authorities rarely even arrest johns. Under federal law, those found guilty of engaging in sex with a minor can face between a 10- and 15-year mandatory minimum sentence, though in many states charges are now always pursued, officials testified.

Bringing charges more routinely, FBI Agent Michael Harpster said, would require a reallocation of resources. “Our resources are currently aimed at victims,” said Harpster, the chief of the FBI’s violent crimes against children section.

Congress estimates 100,000 children are sold in the U.S. sex trade every year. Many exploited children come from the foster care system or are runaways from sexually and physically abusive homes. Out of the 450,000 youth that runaway from home each year, one-third are estimated to be lured by pimps within their first 48 hours on the street. Congress has already taken steps to fight trafficking in the U.S., having introduced and passed several anti-trafficking bills in recent sessions, though committee members said more must be done.

In 39 states, child victims of sex trafficking could face criminal charges if police catch them. Withelma Ortiz Walker Pettigrew, who was a victim of trafficking between ages 10 and 17, said Wednesday that her experiences behind bars were just as traumatizing as her experiences with her pimp.

“This is not prostitution and it should not be treated as such,” Pettigrew said. “This is child rape.”

TIME Congress

Democrats Look to Force Vote on Immigration Reform

Nancy Pelosi
House Minority Leader Nancy Pelosi of Calif. meets with reporters on Capitol Hill in Washington, Thursday, March 13, 2014. AP Photo/J. Scott Applewhite

House Democrats have introduced a petition to force a vote on the comprehensive immigration reform bill that passed the Senate last year before stalling in the GOP-controlled House. But even Minority Leader Nancy Pelosi concedes the effort is unlikely to succeed

House Democrats on Wednesday introduced a petition to force a vote on the bipartisan comprehensive immigration reform bill that passed the Senate last year but stalled in the GOP-controlled House.

The so-called discharge petition, if successful, would force the chamber to vote on legislation Republican leaders have said they have no intention of bringing up, preferring a piecemeal approach to the contentious issue. A majority of the House, or 218 members, would have to support the petition in order to force a vote, which is unlikely even by House Minority Leader Nancy Pelosi’s own estimation.

But President Barack Obama welcomed the move.

“Last year, Democrats and Republicans in the Senate came together to pass a commonsense bill to fix our broken immigration system—a bill that would grow our economy, shrink our deficits, and reward businesses and workers that play by the rules,” Obama said in a statement. “But so far, Republicans in the House have refused to allow meaningful immigration reform legislation to even come up for a vote. That’s why, today, I applaud the efforts of Democrats in the House to give immigration reform the yes-or-no vote it deserves.”

The Senate-passed bill would secure the nation’s borders and provide an earned pathway to citizenship—a move opposed by conservative Republicans who decry it as amnesty. Democrats on Wednesday also touted a new finding by the nonpartisan Congressional Budget Office score that it would cut the deficit by $900 billion over 20 years.

“We’ll never get to 218 on the discharge petition,” Pelosi, a California Democrat, told Sirius XM Radio at an event earlier this month. ”Because the Republicans generally won’t sign, but the fact that it is there and the outside mobilization is saying all we want is a vote.”

House Speaker John Boehner’s only response on Wednesday was a wry statement from his spokesman. “We agree with Rep. Pelosi,” spokesman Michael Steel said, referring to Pelosi’s admission that the discharge petition won’t succeed.

If the bill were to ever come to the floor it would likely pass with mostly-Democratic support and the backing of some 40 Republicans who have voted for similar measures in the past. But no Republicans are willing to embarrass their leadership on an issue the majority of the conference clearly doesn’t support. The three GOP cosponsors of the Democratic immigration bill in the House have said they would not sign the discharge petition.

All that means Wednesday’s move will amount to little more than political posturing, a show of support for Latino and immigrant groups by Democrats meaning to shame Republicans on the issue ahead of the midterm elections.

“More than anything, this discharge petition is a nod to growing pressure from the grassroots,” said Pramila Jayapal, chair of the pro-reform group We Belong Together. “We know that the majority of Congress agrees with us. We believe that the votes are there on both sides of the aisle to pass truly bipartisan, comprehensive immigration reform, and we strongly support this effort to bring a bill to a vote.”

This is the Democrats’ third discharge petition so far during this Congress. The other two, on bills to raise the minimum wage and extend unemployment insurance, also failed to garner GOP support. The last successful discharge petition in the House was for a campaign finance reform bill in 2001.

TIME Health Care

Poll: Many Uninsured Don’t Know Time is Running Out

A new survey shows the Obama Administration's publicity campaign still hasn't reached a lot of Americans without insurance

Just 39% of uninsured Americans know that the deadline to sign up for insurance under the health care reform law is less than a week away, according to a new poll.

The latest tracking poll from the Kaiser Family Foundation finds that, among uninsured adults, 43% don’t know when the deadline is or refused to answer. Five percent believe the deadline has already passed and 13% think it’s later this year.

The deadline for Americans without Medicare, Medicaid or job-sponsored insurance to sign up for a new private health plan through the Affordable Care Act’s federal or state exchanges is Monday, March 31. Those who remain uninsured after that date may be subject to federal fines and will be locked out of the individual private insurance market until open enrollment begins against in November. Those who experience a major life event, like a job loss or marriage, will be able to purchase insurance in the interim. (Expecting a surge in demand right before open enrollment closes, administration officials said Tuesday that Americans who begin the process of enrolling om coverage by March 31 will be able to complete the process after that date.) The fine for not having insurance in 2014 is $95 per person or 1% of income, whichever is greater. Those who meet certain criteria will be exempt, however.

The Kaiser poll, conducted March 11-17, also found that 50% of uninsured adults plan to remain without health coverage, despite the law’s new exchanges and federal subsidies to reduce the cost of premiums. Two-thirds of the uninsured are aware Americans must have insurance or pay fines, while just 57% realize the law provides the subsidies, according to the poll.

The gap between those who approve and disapprove of the ACA narrowed from 12 to eight points between February and March, with 46% now saying they have an unfavorable view of the law, 38% saying they have a favorable view and 15% saying they do not know. Among just the uninsured, the change was far more pronounced. In February, 56% of the uninsured said they had an unfavorable view of the ACA, while 22% had favorable views; in March, those numbers moved to 45% and 37%, respectively.

According to the latest figures released by the Department of Health and Human Services, at least five million people have signed up for new private health plans through state and federal exchanges.

TIME Immigration

White House to Review Deportation Practices

US President Barack Obama speaks about modernizing overtime protections before signing a presidential memorandum at an event in the East Room of the White House in Washington, D.C., USA, on March 13, 2014.
US President Barack Obama speaks about modernizing overtime protections before signing a presidential memorandum at an event in the East Room of the White House in Washington, D.C., USA, on March 13, 2014. T.J. Kirkpatrick—EPA

President Obama tasks the Department of Homeland Security with finding better ways of conducting the practice in an aim to placate angry reform advocates

The White House said Thursday it would review the nation’s deportation practices to see if the efforts can be carried out more “humanely.”

The announcement came during a meeting between President Barack Obama and leaders of the Congressional Hispanic Caucus to discuss immigration reform efforts that are stalled in Congress, and at a time when reform advocates are increasingly angry with the administration over its high rate of deportations.

“The President emphasized his deep concern about the pain too many families feel from the separation that comes from our broken immigration system,” the White House said in a statement describing the Oval Office meeting. Obama told lawmakers that he has asked Secretary of Homeland Security Jeh Johnson to “do an inventory of the Department’s current practices to see how it can conduct enforcement more humanely within the confines of the law.”

Obama has been pressing House Republicans to take up immigration reform legislation for months, after the Senate passed a comprehensive reform bill last year.

“It is clear that the pleas from the community got through to the President,” said Rep. Luis Gutierrez (D-Ill.) said in a statement following the meeting. “The CHC will work with him to keep families together.”

TIME Aviation

Judge Shoots Down Drone Ban

Christopher Brown, co-owner of Next New Homes Group, uses his multi-rotor helicopter drone to take aerial video of a home in Sacramento, Calif., on Feb. 25, 2014.
Christopher Brown, co-owner of Next New Homes Group, uses his multi-rotor helicopter drone to take aerial video of a home in Sacramento, Calif., on Feb. 25, 2014. Randy Pench—Sacramento Bee / MCT / Sipa USA

A federal judge has struck down an FAA-imposed fine against drone operators, ruling there's no legal way to prevent the commercial use of small unmanned aerial vehicles. The FAA can issue an emergency rule that bans small drones if it chooses to appeal the decision

A federal judge on Thursday struck down a fine imposed by the FAA against drone operators, saying there is no law preventing commercial use of small unmanned aerial vehicles.

In his ruling, National Transportation Safety Board Administrative Law Judge Patrick Geraghty said the government’s policy notices were not enforceable because they had not been written as part of a formal rule making process. In the case, the FAA fined a Swiss drone operator $10,000 for for operating a drone recklessly while filming an advertisement for the University of Virginia’s medical school. Geraghty’s ruling dismissed the fine.

The ruling could open up airspace below 400 feet to myriad commercial activities, from farmers surveying crops to pizza delivery. The FAA’s policy was based on handling model aircraft, but in 2007 the agency began applying it to drones as well. In the intervening years, businesses have found more and more uses for small drones, from filming aerial shots for movies to delivering small goods. After a video went viral of a Minnesota beer company delivering beer via drone to ice fisherman, the FAA prohibited the practice.

After Thursday’s decision, the FAA could issue an emergency rule banning small drone use while launching an appeal, which would go to the U.S. Court of Appeals for the District of Columbia.

[Politico]

TIME Domestic Policy

Paul Ryan Critiques War on Poverty In New Report

Paul Ryan
House Budget Committee Chairman Rep. Paul Ryan, R-Wis. is seen on Capitol Hill on March 18, 2013 J. Scott Applewhite / AP

Wisconsin Republican Congressman Paul Ryan is taking aim at government programs he says haven't done enough to lower the United States' poverty rate

House Budget Committee Chairman Paul Ryan released Monday a Republican critique of the War on Poverty begun by President Lyndon B. Johnson 50 years ago, in an election-year counterpunch to the Democratic Party’s claim that it can better provide for the most vulnerable Americans.

Ryan’s report says that federal healthcare, nutrition and education programs have failed to adequately address the country’s poverty rate, which it states has only fallen 2.3 percentage points—from 17.3 percent to 15 percent—since 1965.

The report documents what it says are a multitude of overlapping federal programs on food aid, housing and education, with $799 billion spent on a total of 92 separate federal anti-poverty programs. It states that Medicaid, which was expanded under the President’s new healthcare law, has “little effect on patients’ health” and “increases use of the emergency room inappropriately.” The education program Head Start, an Obama Administration priority, “does not improve student outcomes,” it says, and is “vulnerable to fraud.”

The document also hits at food stamps, which are now claimed by over 47 million Americans at a cost of nearly $80 billion. The Ryan report states that food stamps administered by the Supplemental Nutrition Assistance Program have only a “modest effect on poverty” and “discourages work” among female-headed households and married men.

The document does not suggest concrete solutions, although it puts forward broad outlines for reform. On education, for example, the report cites an academic study suggesting a “consolidated, well-funded system would be better” than the current slate of early-care and education programs. The report also praised the Earned Income Tax Credit, a tax credit for lower income workers.

Ryan’s aides said the report was never intended to be a policy blueprint. “The purpose of this report is to inform the public debate,” says a Ryan aide. “It challenges critics of reform to defend the status quo—to go beyond mere intentions and focus on results. I would expect Paul Ryan to have more to say in this area in the year ahead.” Speaker of the House John Boehner said Thursday that he expects Ryan to produce a complete, balanced budget this year, which may include reforms to anti-poverty programs.

Democrats have had ample time to prepare for a Republican pivot towards poverty. Republican Senators Marco Rubio and Rand Paul, and House Majority Leader Eric Cantor have all given major addresses on the subject in the past few months. “If past is prologue, this report is simply laying the groundwork to slash social ­safety-net programs,” said Rep. Chris Van Hollen (D-Md.), the ranking Democratic member on the House Budget Committee, in a statement. “I hope this time is different, but I fear it won’t be—this one-sided report was put together without any effort to reach across the aisle.”

You can read the full report here.

TIME Domestic Policy

Industry Reacts Cautiously to FDA Nutrition Label Makeover

The food industry reacted cautiously Thursday to proposed changes for nutrition labels, but industry watchers said businesses would likely work cooperatively with the Food and Drug Administration as it finalizes new rules in the coming years.

“We look forward to working with the FDA and other stakeholders as these proposed updates to the Nutrition Facts label make their way through the rule making process,” the Grocery Manufacturers Association said in a statement.

The measured response came after First Lady Michelle Obama and the FDA laid out the first changes to nutrition labels on food since they were first required two decades ago, with a greater emphasis on calories, added sugars and realistic serving sizes.

“Our guiding principle here is very simple: that you as a parent and a consumer should be able to walk into your local grocery store, pick up an item off the shelf, and be able to tell whether it’s good for your family,” Obama said in a statement Thursday morning. “So this is a big deal, and it’s going to make a big difference for families all across this country.”

The proposed changes have to go through a 90-day public comment period, and after that it will take at least a couple years of working with the industry for them to be finalized and enforced.

“The bottom line for the industry is that the consumer has to buy the product,” said Dr. Caroline Apovian, a spokeswoman at the Endocrine Society and an expert on obesity. “The industry is going to make as many changes as we want them to as long as the consumer buys it.”

The changes the FDA is proposing target issues nutritionists have been griping about for years. The new labels would provide more realistic serving sizes—the serving size for ice cream, for example, will be increased so that a pint is shown to hold about two servings instead of four, as it’s presented now. The adjusted serving size will increase the calorie count to about 400 calories per serving. The new labels would also inform consumers of how much sugar and sweetener have been added to products. Bonnie Liebman of the Center for Science in the Public Interest said that provision will probably face the most backlash from the businesses.

“The food industry doesn’t want to disclose added sugar because many products are high in added sugars and it makes those foods look bad,” she said.

One chocolate bar has about 77.4 calories from added sugar alone, according to the American Heart Association, and a can of soda has about 132 calories from added sugar per serving. “The fact is the average person wants to know how much sugar has been added to their yogurt,” Liebman said. “And right now you can’t tell.”

Constance Brown-Riggs, a spokeswoman at the Academy of Nutrition and Dietetics, said teaching consumers how to read the new labels will be critical, regardless of which changes are or aren’t made.

“Even with the old Nutritional Facts Panel the one thing people miss is that it requires education,” she said. “The same will be true with the new label.”

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