Like it or not, the Patient Protection and Affordable Care Act, also known as Obamacare, is the law of the land.
Besides passing a Democratic-controlled Congress in 2010 and receiving the blessing of President Obama, Chief Justice John Roberts, a Bush 43 nominee, upheld the law last summer when he cast the deciding U.S. Supreme Court vote, 5-4.
That being said, the massive federal health-care overhaul still faces many challenges, not the least of which is the laws near irreconcilable complexities and consistent unpopularity.
Heres a look at the top 10 obstacles and concerns Floridians should know about the largest social entitlement since Medicare.
1. People dont like it.
In the past six weeks six major polls have all shown significant disapproval ratings.
Most recently, a CBS News poll released Wednesday found more Americans than ever want the Affordable Care Act repealed. According to the poll, 39 percent want Congress to get rid of Obamacare entirely, while 36 percent want to keep it. The poll also showed an 18 percent disapproval margin.
An NBC News/Wall Street Journal poll, also released Wednesday, showed Americans think Obamacare is a bad idea, 47-34. The 13 percent negative approval rating is the largest of 10 NBC/WSJ polls.
Some provisions, however, such as requiring insurance for individuals with pre-existing conditions, are highly regarded.
2. Gatorland
Call it the Gatorland effect. U.S. Sen. Marco Rubio, R-Fla. -- no fan of Obamacare -- recently called the Central Florida alligator theme park known as Gatorland a poster child for the demands the health-care law is placing on businesses.
Gatorland employs roughly 135 Orlando area workers and pays 80 percent of its employees health insurance, according to an Orlando Sentinel op-ed. But new compliance costs are leading to job cuts, reduced hours and higher prices for customers.
3. The Oklahoma Challenge
Perhaps the most serious remaining legal obstacle facing full implementation of the Affordable Care Act, Pruitt v. Sebelius, is Oklahomas broadside against the Internal Revenue Service expansion of the employer mandate.
Under the law, government subsidies are only allowed in state-run exchanges. And, penalties on employers are triggered when employees use government subsidies to buy insurance on the state exchanges, as opposed to receiving insurance from their employers.
Its complicated, but basically: No state-exchange equals no subsidy equals no penalty.
Thirty-four states, including Florida, do not have a state-run exchange. Florida will have a federally run exchange in 2014. A federal court heard oral arguments on the case June 20.
4. Democrats are running for cover.
According to the Washington Post, once loyal Democrats have been steadily turning away from Obamacare.
Moderate congressional Democrats were swept out to sea for their Obamacare votes in the 2010 mid-term elections. Eager to avoid a repeat in 2014, Democrats are now supporting the Obama administrations recent delay of the employer mandate until 2015.
In Florida, freshman Rep. Patrick Murphy said in recent news release he was pleased to hear of the (Obama) Administrations decision to delay penalties for businesses under the Affordable Care Act.
Florida U.S. Sen. Bill Nelson, D-Fla., also supports delaying the employer mandate, though he still approves of expanding Medicaid, the Tampa Bay Times reported.
5. Removing Anti-Fraud Measures
On the Friday of the Fourth of July holiday week, the Department of Health and Human Services quietly announced it was delaying anti-fraud measures because of administrative complexities.
Basically, income and current insurance claims will not be verified when individuals apply for taxpayer subsidies when buying health insurance through state exchanges beginning Jan. 1, 2014.
(Note: Those who sign up on the Internet can list any income they like, and it won't be caught for an undetermined amount of time -- if ever.)
6. State and local governments are subject to the insurance mandates.
Obamacare doesnt just apply to the private sector, but the public sector, too.
A spokesperson from the Florida Department of Management Services confirmed with Florida Watchdog the state government is not only subject to the employer mandate, but is reviewing the federal change (employer delay) to see whether there is an effect on the state level. In other words, its not sure what to do.
But local governments such as Brevard County are already considering tough choices. Brevard is weighing the prospect of cutting hours for hundreds of part-time workers to avoid substantial costs due to the new insurance requirements.
7. Coming soon: a massive taxpayer-funded advertising push.
Due to low public regard for the health-care law, combined with the fact that many Americans arent aware of its current status 42 percent, according to a Kaiser Family Foundation Poll the federal government is about to launch a massive new media blitz to get people, especially young, healthy people, to enroll.
According to the Associated Press, the federal governments marketing strategy includes everything from door-to-door walks, working with churches, partnering with local mayors and a massive social media presence, including phone apps, Facebook, Twitter and Flickr campaigns.
8. Enrollment and Outreach
Courtesy of the Department of Health and Human Services, $150 million was pumped into state health centers this month for the purpose of hiring new workers devoted to enrolling people in health exchanges.
Florida received $8 million and will hire 163 new workers.
9. The Data Services Hub
The Data Services Hub is a massive networking hub that will be used to determine eligibility and compliance with Obamacares many new regulations.
The database has stoked privacy fears as millions of Americans personal information will be compiled and accessed by seven federal agencies, including the Internal Revenue Service, the Department of Homeland Security, the Social Security Administration and the Department of Defense.
By mid-December, the federal government is planning to quietly enact what could be the largest consolidation of personal data in the history of the republic, wrote Stephanie T. Parente in USA Today.
10. Unions dont like Obamacare, either
Unions are charged with looking after their workers, and after first supporting the health reform, many are now apparently against it.
The unintended consequences of the ACA are severe. Perverse incentives are already creating nightmare scenarios, wrote Teamsters president James P. Hoffa in a letter to congressional leaders.
Among the concerns is the incentive for employers to cut workers hours below 30-hours per week. Additionally, union members with nonprofit health insurance plans will not be eligible for government premium subsidies, but they will be taxed to support subsidies for non-union members.
Contact William Patrick at william@floridawatchdog.org or follow Florida Watchdog.
