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The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By John Pearson
July 18, 2017
Recently, Senate Republicans released a “discussion draft” of a bill to repeal and replace the Affordable Care Act (ACA). This column offers an overview of how to read and implement legislation.
The Basics – Bills, Public Laws and the U.S. Code
It is essential to understand these documents.
The public can track bills, Public Laws and the U.S. Code from congress.gov.
Section 104 of the “Discussion Draft”
Section 104 repeals the ACA’s individual mandate to purchase health insurance.
SEC. 104. INDIVIDUAL MANDATE.
(a) IN GENERAL.—Section 5000A(c) of the Internal Revenue Code of 1986 is amended—
(1) in paragraph (2)(B)(iii), by striking ‘‘2.5 percent’’ and inserting ‘‘Zero percent’’, and
(2) in paragraph (3)—
(A) by striking ‘‘$695’’ in subparagraph(A) and inserting ‘‘$0’’, and
(B) by striking subparagraph (D).
(b) EFFECTIVE DATE.—The amendments made by this section shall apply to months beginning after December 31, 2015.
How to Analyze Section 104
Subsection (a) of section 104 directs certain changes to the existing section 5000A(c) of the IRS Code. To fully understand subsection (a), you may need to create a merged version of section 5000A(c) with the new text from subsection (a).
Subsection (a) reduces all penalty provisions that apply to individuals to zero and eliminates the indexation feature.
Subsection (b) gives the effective date for section 104. It does not direct any changes to the U.S. Code.
High Level vs. Detailed Level Understanding of Legislation
For top agency executives, politicians, and the press, it may be sufficient to have a bulletized understanding of legislation. Maybe a politician can recite 10 bullets concerning the 142-page draft bill. Maybe a newspaper article would cover 10 bullets. However, politicians and the others cited would not necessarily understand the details in section 102, which is more complex. Only a few people on Congressional staffs or inside the bureaucracy might have a full understanding of section 102. No one person may understand the full details of the entire 142-page Senate bill. Bureaucracies use specialization to insure that they have experts for all sections in legislation.
Approach to implementation
If section 104 became law, here’s how you might approach the implementation.
The Effective Date Provision
Section 104 appears to be a relatively simple legislative change. But subsection (b), the effective date provision, may be problematic.
Does subsection (b) mean a person who paid a penalty in 2017 (for failure to have health insurance in 2016) should receive a refund of the penalty? If so, refunds don’t just magically happen. You will need to write a project request (or whatever your agency calls it) so the IT department knows precisely what should happen. The IT department will use a formal process for software changes, which includes analysis, coding, and testing. You may be part of the testing and you may need to assist with the analysis. Exactly how do you determine from agency databases which persons are entitled to receive a refund for penalties paid in 2017? You don’t want refunds going to the wrong people or in the wrong amounts and you don’t want to miss people who should receive a refund.
I personally disagree strongly with the elimination of ACA’s individual mandate. We need millions more people (especially healthy people) to be enrolled in the private insurance markets to make these markets work properly to deliver affordable insurance. But if I were a current government employee or contractor assigned to implement section 104, I wouldn’t dream of resisting the implementation. You often have to set aside your personal values and beliefs. Your duty is to implement the laws as written.
Author: John Pearson recently retired from a lengthy career in the federal government where he was a program analyst. He has an MPA and a bachelor’s degree in economics. He now writes columns reflecting on his experience in government. His email is [email protected].
John Riggins
July 26, 2017 at 5:06 pm
Intervening in a market, such as insurance, does not make the market work properly. It is a value statement that the market is believed to have failed in some manner and requires government intervention. has the medical or health insurance market failed? Market rates are established through actuarial calculations of the relative risk of providing service to an individual based upon certain factors, such as age, lifestyle choices, gender, and past medical history. in one value system, if an individual is a poor risk, they should pay more for coverage, while in another value system, regardless of the monetary risk the individual poses to the insurer, they should be able to receive affordable insurance. That affordable insurance is provided at the expense of other, less risky, insured individuals.
From my perspective, the issue is not about whether or not everyone deserves to have access to health care, but rather whether or not it is right to force individuals to purchase products they do not want, in this case health insurance, in order to lower the cost for higher risk individuals. in reality, we already do this with USDA price support programs, which purchase large volumes of dairy products in order to artificially support the market, making the market behave as though there were more demand than there actually is.
It will be interesting to see how this plays out in the future. Enormous cultural changes are taking place, many of which may result in unsustainable public policies in the absence of significant nonpartisan forethought and collaboration. I fear we have lost the capacity or desire for either.