The Orwellianly-titled American Health Choices Act, a health care overhaul bill the Senate Health, Education, Labor, and Pensions (HELP) Committee passed Tuesday with a 13-10 party line vote, contains a two-pronged mechanism for increasing government’s already enormous footprint within the health care market, and for driving private insurance into the ground.

When the first public draft of the American Health Choices Act (AHCA) was released at the beginning of June, it contained language mandating that employers with 25 or more workers offer health insurance to their employees or face a federal fine. The level of that fine, as with almost every other penalty and tax increase provided for in the bill, was to be left to the discretion of the Secretary of Health and Human Services. This new ability to impose taxes and levy fines of an amount entirely at her discretion would be a breathtaking expansion of the appointed HHS Secretary’s power.

When an evaluation by the nonpartisan Congressional Budget Office found the AHCA’s net cost – that which would have to be spent above built-in revenue increases and offsets – to be around $1.6 trillion (a number that many experts and outside evaluators find to be reminiscent of the Medicare forecasts at its inception, which put the cost of the now-$37 trillion program at less than $10 million), while only extending health coverage to approximately a third of the 45 million American uninsured, public backlash was significant enough that the HELP committee members writing the bill took steps to bring that projected cost down from a trillion and a half dollars into the hundreds-of-billions range.

Establishing Employer Fines

Sens. Edward Kennedy (D-MA) and Chris Dodd (D-CT), the chief architects of the AHCA, did this in two ways. First, they took over one of the jobs they had delegated upward to the Secretary of HHS: establishing the dollar amount employers with 25 or more workers would be penalized for not offering health insurance. They set these penalties at $750 annually per full-time employee, and at $375 annually per part-time worker.

This dollar amount is significant for two reasons. First, small businesses, which employ almost half of working Americans according to the National Small Business Association (NSBA), often don’t provide health insurance to employees because they simply cannot afford to do so. Adding $750 per worker to those cash-strapped businesses’ overhead costs will make cuts somewhere else necessary. Whether those savings come in the form of employee pay cuts, freezes on hiring, or layoffs, workers are the ones who will feel the pain from this attempt by Washington to “help” them by penalizing their employers.

Second, larger employers, which currently shell out an average of $4,704 a year for individual workers and $12,680 for those with dependents (numbers courtesy of the Kaiser Family Foundation) will see the option of a $750 annual fine as an incredibly desirable alternative to continuing to pay thousands of dollars for every employee’s health insurance. By dropping the coverage they currently offer workers, larger employers will be able to save anywhere between four and twelve thousand dollars on health benefits alone – a no-brainer of a decision.

Adding Workers to Government Rolls

This brings us to the second major change made to AHCA: creating a government-run “public option” that allows uninsured individuals – or, say, workers whose employer decided to save a few thousand dollars by trimming benefits – to go to the federal government for coverage. With a government-backed program waiting with open arms to scoop up any and all comers, whether they are currently insured or not, employers can comfortably know their workers will be covered insurance even while their businesses save thousands per head by ending their funding of that coverage.

This is one of the many reasons a government-run insurance “option,” which prominent Democrats like Senate Finance Committee member Charles Schumer (D-NY) are so forcefully supporting, is a danger to the health care market as we know it. The “public option” is designed to enter a government-run insurance provider into open competition with private coverage-providing entities. Though politicians from the president down have been insistent about their intention to have that competition take place on a “level playing field,” promises like that from a federal entity that makes the laws, prints the money, and – perhaps most importantly – doesn’t have to make a profit to stay in business ring very
hollow indeed.

All proponents of this government-run insurance program may not share the views of Rep. Jan Schakowsky (D-IL), who earlier this year promised a group of pro-socialized medicine activists that a public option was being established as a means of imposing “single payer” (read: government-run) health care on America and assured her audience that the federal government wasn’t interested in waging a “principled fight.” Kennedy and Dodd specifically told their colleagues in a letter released to the press that the AHCA “virtually eliminates” the likelihood employers will respond to the availability of a government-run insurance option by dropping funding for employee coverage. However, the consequences of this bill are plain to see, even if these U.S. Senators aren’t capable of understanding (or of honestly explaining) the consequences of their legislative actions.

Driving the Market out of Business

Health care consulting and analysis firm Health Systems Innovations, which analyzed the AHCA in June, estimated that the government-run insurance option provision would “likely crowd out at 79 million individual contracts with existing private insurers.” HSI also estimated that the entire bill would cost at least $4 trillion to implement – nearly three times the CBO’s estimate.

This massive move by the federal government to crowd private insurers out of the market through the imposition of a national employer mandate and the establishment of a government-run insurance option would be, as Schakowsky eagerly predicted, the end of the private health care market as we know it. Whether it comes as an unintended consequence of actions taken by legislators who are too short-sighted to see the havoc their bill will wreak on our health care system, or as a significant milestone in an intentional takeover of the private market, the result will be the same – and it will not be positive in any sense of the word.

Published at PajamasMedia