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Delay in ACA's employer mandate nothing to celebrate

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The glee with which Republicans greeted the delay in the employer coverage provision of the Affordable Care Act is heartless. Although it is politically motivated, such reveling will prove to be a political obstacle to Republican election chances in 2014. President Barack Obama's health care law is not going away. A groundswell of public opinion will welcome the reforms now under way to help correct the fundamental inequities in America's health care system.

Celebrating the temporary delay in implementation of the ACA as a harbinger of the law's end callously ignores the many Americans whose health is suffering from lack of coverage for payment. For another year, those who cannot afford expensive insurance premiums and who are too poor to be required to pay the mandate will pay nothing — and just hope they do not get sick (or sicker). The structure of the ACA depends partly on ensuring that employer coverage continues to play a role. But businesses, complaining about the new reporting requirements and penalty alternatives to employee coverage, are threatening to opt instead for temporary employees working less than the 30 hours that would qualify them for employer coverage. And many Republican-run states have delayed the new health care exchanges with their premium support for those with low incomes.

So, although this delay affects a relatively small number, we have poor people making less and getting less coverage for their health care. It seems a bit much for a politician to be joyful about that.

But hear them carp and crow: Sen. John Barrasso, Republican of Wyoming, called the administration action "a cynical political ploy to delay — until after the 2014 elections." Senate Republican leader Mitch McConnell of Kentucky said the fact remains that Obamacare needs to be repealed. As reported by Politico's Brett Norman and Jennifer Haberkorn, House Speaker John Boehner's press secretary, Brendan Buck, tweeted simply: "Obamacare. Such a train wreck." "Absolutely thrilled by #ObamaCare delay," Republican operative Brad Dayspring tweeted. "Will help #GOP candidates across the board in 2014. Debate will be a repeat of 2010."

"Employers need more time and clarification of the rules of the road before implementing the employer mandate," Randy Johnson of the U.S. Chamber of Commerce reportedly emailed. But sympathy with the businesses that must adapt to the new law is misplaced. True, some final details from the Department of Health and Human Services were delayed, but there was no secret about it. Companies had just under four years to prepare. Many businesses took a chance that the Republican reassurances against needing to comply were accurate, and now that implementation of the law is a reality we hear these belated declarations about how little time they have.

That it will be a "replay of 2010" may be partly right, but Americans now can envision a doctor for every family. We are no longer misled by intemperate ranting against "Obamacare." And remember what happened after 2010: a second term for President Obama, a gridlocked House and conservatives blustering that the problem was not the message, it was the packaging? Approval and disapproval of the law remain about split in Kaiser polls, in spite of a massive conservative misinformation campaign. And many of the 40 percent who don't realize that the law is in force will become knowledgable supporters in early 2014 when they suddenly can get health insurance.

People will understand the necessity of this reform. That was the lesson from 2010, and if the same arguments bubble up again, they will only strengthen those candidates in 2014 who stand for sensible public responsibility instead of callous partiality to destructive rhetoric.

The request for this delay exemplifies the needless administrative complexity required by the health care insurance business. Simplification to a single federal payment source would save lives and money. The Supreme Court has cleared the way, at least in concept, for increased federal health care taxation. Although Sen. Max Baucus triumphantly dismissed single payer as "off the table" in 2009, given these unfolding realities it might be welcomed back soon.

Dr. James Burdick, a professor of surgery at Johns Hopkins University School of Medicine, had a career as a transplant surgeon and was director of the Division of Transplantation in the Department of Health and Human Services. A frequent op-ed contributor on health care issues, he is writing a book detailing his doctors' plan for health reform. His email is jburdic1@jhmi.edu.

Copyright © 2014, The Baltimore Sun
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