Obama Proposes  an Independent  Board
To Play Leading Role in Health-Care Law

By Harry Kelber

It took more than a year of economic in-fighting and  political wrangling for President Obama to get what he wanted: a health care law, even with its imperfections, on which his legacy may depend.

The new health-care law will cost the federal government $940 billion over 10 years, but it is expected to extend coverage to 32 million uninsured people and be able to save $138 billion during this decade, according to projections of the Congressional Budget Office (CBO).

The important  provisions of the 2,400-page health-care legislation are confusing to most people, especially since many of the significant features do not go into effect until 2014. Between now and then, millions of currently insured people may be forced to drop their coverage because of unaffordable increases in premiums, co-payments and out-of-pocket costs.

One of the main provisions of the law, including the creation of state insurance exchanges where uninsured Americans can shop for competitively priced policies, will also  not take effect  until 2014.

Many working people are unaware that they will be penalized if they don’t possess  the health insurance coverage  mandated by the law, even if they cannot afford it, despite government subsidies. They will have to pay an annual  penalty of $695 per person up to $2,085 per family, or 2.5 percent of their family income, whichever is greater.

While considerable confusion  remains about the fate of Medicare and Medicaid,  integrating 32 million people into the health program represents formidable administrative problems.  And what about policing the mandate that may compel more than tens of millions of the population to buy and maintain health insurance?

A Board of 15 Appointees Will Regulate Health-Care Law

President Obama plans to nominate 15 members of an Independent Payment Advisory Board for six-year terms for what are to be full-time jobs overseeing the health-care law., While Senate confirmation  is required, the board could put its own proposals into effect unless Congress modified or rejected them within 30 days.

The board was a top priority for Obama during the long legislative battle on health insurance. He faced down Democratic leaders who opposed delegating powers to an unelected board that would influence the future of Medicare, Medicaid and possibly Social Security.

With the federal debt projected to rise to levels that many economists consider unsustainable, mainly due to growing health costs and an aging population, Congress might have little choice in coming years but to accede to unpopular limits on cutting payments to  health-care providers  and beneficiaries. The board would give them  political cover to do so, while deflecting criticism from the Obama administration.

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The health insurance law is really a work in progress. It has, as yet, no staff to administer a new national law with a complexity of problems about which key decisions still have to be made. Although it establishes a mandate that penalizes people who do not have insurance  after 2018,  it has no mechanism to police and enforce any requirements of the new law.

A new bureaucracy will have to be in place by 2014, with the authority to take whatever actions are necessary to carry out the purposes of the law. In fact, there are questions about how much staffing will be needed or where the money will come from to finance these operations.

The merits and shortcomings of the health insurance measure will almost certainly be debated  from now  to the mid-term elections. The AFL-CIO  should be clear about what  changes in the law it favors and what it opposes. It  should present these views forcefully in the remaining six months of the election campaign.

 The important thing to keep in mind is that the provisions of the health care insurance law are not carved in stone. Significant  changes can still be made. for better or worse. We have a second chance to reshape and improve the  law in behalf of the nation’s working families.

Let’s make the most of it.—Harry Kelber