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Debating the Pros and Cons of the Affordable Care Act

posted on Wed, Feb 19 2014 11:05 am by Alexandra Brandes

Holding events and featuring guest speakers is one way that students can become more involved in the field of public health law. Alexandra Brandes, a member of Tulane University’s Disability and Health Law Society and the Student Network for Public Health Law, describes an event her student group held during the fall 2013 semester. If you would like to hold a similar event, reach out to the Student Network at studentnetwork@networkforphl.org.

As full implementation of the Patient Protection and Affordable Care Act (ACA) continues, the controversy about its provisions has become more acute. To gain a better understanding of different approaches to the ACA, the Disability and Health Law Society and the Federalist Society at Tulane Law School hosted a debate about the ACA at the state level.

Two experienced lawyers were asked to debate the pros and cons of the ACA. Robert Alt, J.D., Visiting Fellow at The Heritage Foundation, spoke about challenges of the ACA; and Dr. James Tran, J.D., M.D., Adjunct Professor of Law at Tulane Law School with a focus on Healthcare Law, discussed the positive aspects of the ACA.

Mr. Alt began by discussing the direct and indirect issues with the ACA, focusing on the poor rollout of the healthcare exchanges and the government's inability to hit the projected enrollment numbers to date. He outlined issues with the individual mandate penalties and stated that many people, particularly students like those in attendance at the discussion, would be financially better off to accept the penalty than to sign up for health insurance. Mr. Alt reasoned that if a student only has to worry about getting an unexpected illness or injury, then health insurance does not make economic sense.

There are also unintended consequences of the ACA, according to Mr. Alt, related to employers either making significant cuts to their part-time workforce or moving full-time employees into part-time in order to avoid incurring new health insurance coverage costs. Additionally, he said, companies like UPS are cutting coverage for spouses in their insurance plans.

Dr. Tran discussed the structure of ACA insurance requirements (individual mandate, employer mandate, and insurance company requirements), then explained that each person or business buying insurance will have access to 10 essential health benefits and minimal essential coverage requirements designated in the ACA.

The different healthcare systems in place (managed care, managed competition, regulation model) were outlined by Dr. Tran. He also explained the calculations that will be used to determine whether an individual qualifies for the premium tax credit and if so, how much they would get in assistance to purchase insurance. He said a student who is not in need of extensive health insurance coverage can obtain a catastrophic plan under the ACA if they meet certain requirements. Essentially, this would cover a student in the event of an unexpected accident or injury, and would not cost them very much each month. Furthermore, while the tax penalty is only $95 in the first year, it increases to nearly $700 after the third year — thus it would behoove students to sign up for the health insurance rather than paying the penalty.

Lastly, Dr. Tran defended the online marketplaces, saying in his experience helping individuals sign up in Louisiana, he encountered a lot of interest and that the web components were functioning better.

When the debate ended, one student asked about the logic behind the policies in the ACA that seemed to create cost burdens for businesses — for instance requiring businesses with 50 or more employees to provide insurance coverage. Dr. Tran explained that the requirement is based on calculations for a 30 hour work week, or 120 hours per month. All the hours of all employees at a business are counted per month, and divided by 120 to determine the number of full time hours worked. Therefore, a company with 100 part-time employees rather than 50 full-time employees may still be required to provide health insurance because it has more than 50 full-time employee hours worked per month.

There are various tax incentives involved in the ACA for small businesses that provide health insurance to their employees, added Dr. Tran. Moreover, employees who do not have an employer plan are going to qualify for subsidies if they are under 400 percent of the Federal Poverty Guidelines. Thus, Dr. Tran explained, the ACA is not as bad for business as it may seem.

Through their debate of the pros and cons of the ACA, Dr. Tran and Mr. Alt provided an enlightening discussion that explained some of the more complex components of the health care law, and helped students get a clearer understanding of the challenges involved in implementing a national public health policy.  

This student blog post was written by Alexandra Brandes, a member of Tulane University’s Disability and Health Law Society and the Student Network for Public Health Law.

The views expressed in this post do not represent those of the Network for Public Health Law or the Robert Wood Johnson Foundation.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The information provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

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