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what you need to know about health care mandates
If businesses get an extra year to meet a new health care mandate, why not everybody else? Republicans, seizing on the White House delay for employers, are demanding that the Obama administration give individual Americans an equal break. But the White House says that's just a thinly disguised gambit for dismantling the entire health care overhaul. What to believe?
The battle of the mandates is the latest clash in the long-running political fight over health care — a fight that's far from over. Here's are some questions and answers in the aftermath of the administration's delay of the employer mandate:
Q What are the law's mandates?
A One is for individuals and another for employers. The individual requirement takes effect in 2014; the employer mandate has been delayed until 2015. Under the health care law, virtually all Americans must carry medical insurance, either through an employer or a government program, or by buying their own policies. Most people are unaffected because they already have coverage.
Q If you don't have it, how do you get it?
A Middle-class individuals and families with no access to job-based health insurance will be able to buy subsidized private coverage through new markets that open Oct. 1. Low-income people will be steered to an expanded version of Medicaid in states that accept it. Those who remain uninsured will face fines that start small — as little as $95 in 2014 — but build up over time. There are exceptions for financial hardship and other circumstances.
Q What about businesses?
A The employer mandate applies to companies with 50 or more workers. They could face fines for not providing coverage, and also if their plan is deemed unaffordable under the law. According to the Kaiser Family Foundation, 95 percent of employers with 50 or more workers already offer health benefits. Nonetheless, it's a big issue for small businesses that are growing, and for companies that employ lots of low-wage workers not currently offered health insurance.
Q If the administration delays one mandate, why not the other?
A The two mandates are in the law for different reasons and purposes. Delaying the individual requirement, which has survived a Supreme Court challenge, would have a much bigger impact. It serves as a stiff nudge to get as many Americans as possible into the insurance pool. The premiums of healthy people are needed to offset the cost of covering people in poor health who currently can be excluded by insurers. "It's what's going to keep the insurance markets from collapsing once we open the door to people with pre-existing conditions," said Timothy Jost, a law professor at Washington and Lee University in Virginia who supports the health overhaul. Starting Jan. 1, insurers are barred from turning away people in poor health.
The employer mandate was designed as a guardrail, to deter employers from dropping coverage and shifting workers to taxpayer-subsidized programs. It's expected to play only a supporting role in the expansion of coverage to millions of uninsured people.
Q: Why are Republicans objecting to a delay in a law they've been trying to repeal?
A: Democrats say the answer is politics. Republicans say they are calling attention to problems with the law that run counter to the administration's reassuring message that everything is on track.