Millions of Americans may be wrestling with computer glitches to try to sign up for Obamacare — but many people eligible just won’t bother and will pay a price for it.
Some will flout the mandate to buy coverage on ideological grounds, a health insurance version of civil disobedience.
Some will opt for the penalty because it’s cheaper than paying for insurance, even with subsidies — as long as they don’t get sick and have to pay their own medical bills.
And some are so confused about the president’s health care law that they may not even realize they have to pay a penalty — or a tax, as the Supreme Court called it — until they get slapped with the fine when they file their 2014 tax returns. And sign-up rates may be affected, too, if the technical problems on the exchange websites persist.
The penalty starts as low as $95 for the first year but then rises. By 2016, according to the Congressional Budget Office, about 6 million Americans will be forking out about $7 billion worth of Obamacare penalties.
The new health exchanges need younger and healthier people to balance out the risk and prevent spiraling insurance costs. The mandate is one way of nudging them in.
Here’s a look at who may opt out — and why they’ll do it.
In reality, there are no “Obamacare cards,” but some conservative groups, notably FreedomWorks, are using the imagery to promote resistance to the law, especially among younger and healthier people.
“My guess is they need about 40 percent of the people in the exchanges to be young, healthy adults under 35,” Dean Clancy, vice president of public policy for FreedomWorks, said in an interview. “If they don’t get that, the premiums will go up in the second year. Insurance companies may back out because they can’t get enough people to sign up, … and the whole thing will collapse.”
FreedomWorks, which is tea party-affiliated, plans to take its campaign to college campuses, where they want students to burn fake Obamacare insurance cards.
Generation Opportunity, another conservative group geared toward young adults, is also planning a campus tour. Evan Feinberg, president of so-called GenOpp, envisions the Obamacare feud playing out at football tailgates. Obamacare advocates will show up with — as he put it — stacks of paperwork asking people to sign up for health insurance, subsidize older people and “give up their privacy.” He added, “We’ll be there with pizza and beer and cornhole, saying come hang out with us instead.”
The group recently released a provocative anti-Obamacare ad that went viral, featuring an evil clown-like Uncle Sam figure who pops up between the legs of a young woman to perform a gynecological exam.
The conservatives are trying to reach people like Eugene Craig, a 23-year-old history major at Bowie State University in Maryland. And he’s convinced. He works part time, earns $18,000 and is on his parents’ insurance. He expects mom and dad to boot him off their coverage in a year or so. Although if they get insured through a job, Obamacare allows him to stay on their policy until he turns 26.
Craig said if he finds himself without health insurance, he’ll pay the penalty — even though his income levels would qualify him for subsidized health insurance on the exchange. In 2014, he’d be fined only $95 for being uncovered. But in a few years, depending on what happens to his income and insurance costs, the tax might actually be more expensive than insurance.
But he plans to opt out on principle.
“I don’t think the government has a proper role in providing health care,” he told POLITICO. “I’d definitely rather be uninsured and out-of-pocket than be on the exchanges.”
But it’s not clear how many people, like Craig, will stay out on ideological grounds. David Williams, chief tax officer at Intuit, is skeptical there will be many.
“Let me warn you, having done a lot of work on statistics: People will tell you one thing, … but their behavior may or may not match what they say,” he said. “And so, I’d be leery of folks who make grandiose statements for or against Obamacare until we see what they actually do.”
Most people who sit out Obamacare will be motivated by math, not politics. These people — mostly the so-called young invincibles — would rather take their chances that they won’t need costly health care, pay the 95 bucks and not spend money on insurance.
Even FreedomWorks’s Clancy agrees that it will usually come down to economics — although if the end result is weakening Obamacare, that’s fine with him.
“The main reason the people will skip the exchange is not ideological but financial,” he said. “This sticker shock will be our best friend in the fight,” he said, referring to the cost of insurance in the exchanges.
Pro- and anti-Obamacare forces agree that much of people’s decisions on whether to sign up will boil down to dollars and cents. The average premiums for the federally run health insurance exchanges came in lower than earlier projections, but averages don’t necessarily mean all that much. Individuals won’t know until they check out the exchanges — and access the troubled websites — exactly what their particular coverage options are and what those would cost.
Clancy and other opponents of the law point to a study by David Hogberg of the conservative National Center for Public Policy Research that says 3.7 million single people age 18 to 34 will save $500 if they forgo insurance and pay the tax in 2014 — and most of them would actually save twice that much.
Other studies have come to different conclusions. A recent study by the Center for Studying Health System Change disputed the stereotype of so-called young invincibles not caring whether they are insured. It found that just 22 percent of 18- to 29-year-olds believe they’re healthy enough to go without insurance. But it also found that 37 percent of the uninsured think health insurance isn’t worth the money. And a recent Gallup poll showed rising awareness of the health law and more interest in coverage. Of the uninsured, 65 percent said they would get health insurance, and 25 percent said they’d pay the fine.
Many experts, including people interviewed at Intuit and H&R Block, expect that a large chunk of the people who pay the tax just won’t know the rules.
“I would say a huge portion of the population is confused or ignorant of what will happen,” Clancy said. “I think a lot of people will drift along passively, unaware that the mandate applies to them.”
The groups working on the ground to maximize enrollment are trying to get the message across. And the message isn’t that penalties are bad but that health coverage is good.
“Helping them to understand that they are protecting themselves and their financial future by getting health coverage is really important, and it is a real challenge,” said Suzie Shupe, executive director of California Coverage & Health Initiatives, which is working with groups across the state to help sign people up.
“This is really going to be a personal decision,” said Jen Mishory, deputy director of the Young Invincibles, a group working to encourage young people to enroll. “It’s a financial and a health decision, and it’s going to depend, in part, on how good a job we can do educating people.”
The $95 penalty number is well-known — but it’s only part of the story. It’s actually $95 or 1 percent of taxable income, whichever is more. (The income penalty would be based on earnings over the so-called filing threshold — the amount earned before someone owes taxes.) For someone making $40,000 with standard deductions, it would mean about $300 more in taxes (or $300 less of a refund).
“I think that the $95 has been really well communicated, … but what has not been communicated as well is the 1 percent, and that is what we heard from clients this year and was really eye-opening,” said Meg Sutton, senior adviser on tax and health care services at H&R Block.
By 2016, the tax will be higher — $695 or 2.5 percent of income, whichever is more.
Sutton said the public is generally pretty clueless that the penalty rises over the years. Still, H&R Block found in a recent study that those who were uninsured were three times more likely to indicate that they are “extremely likely” to purchase insurance rather than pay a tax penalty.
The CBO broke down its projection of 6 million penalty payers by income. About 30 percent will have incomes too high for federal subsidies. Forty percent will have incomes between 200 percent and 400 percent of the federal poverty line, which makes them eligible for the middle range of subsidies. The remaining 30 percent will make less than 200 percent of poverty and would qualify for the highest subsidies — but low-income groups can be hard to reach and skeptical of government assistance.
But as the penalties mount, the calculus will tip toward purchasing coverage, exchange watchers predict. That means the first year is the best chance for the anti-Obamacare groups to undercut the law — as the House has illustrated in the shutdown-repeal-defund campaign.
But as the exchanges mature and people get used to Obamacare, the political climate might calm down. And people may look at the penalty versus premium in new ways.
“I think a lot of people will factor in things like, ‘Well, I ought to have health insurance,’ or, ‘I have kids and want to make sure they’re covered.’ … Or, ‘Oh I haven’t had health insurance for years, but I’m getting older and having health problems,’” Intuit’s Williams said. “So you can envision all sorts of rationales that economists may or may not get to that are personal. … All of that is an art, not a science.”
Original artical here: http://www.politico.com/story/2013/10/obamacare-mandate-some-americans-will-ignore-requirement-98236.html#ixzz2kMta5Nc6
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