Questions Mount As Health Law Rolls Out : Shots - Health News In a few months the federal law overhauling the nation's health system will be a year old. As House Republicans push for a repeal vote, NPR's Julie Rovner answers questions about how the law works.
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Questions Mount As Health Law Rolls Out

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Questions Mount As Health Law Rolls Out

Questions Mount As Health Law Rolls Out

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


As expected, the House of Representatives has voted to repeal the health care law. The vote comes after two days of debate in which Republicans, one by one, took the floor to push for repeal.

SIEGEL: I think it's time we return this House to the people and we can start by repealing the job-killing, socialistic, and out-of-touch health care bill.


That's Jeff Duncan, Republican of South Carolina.

Democrats spent the day defending the law. Here's G.K. Butterfield, Democrat of North Carolina.

SIEGEL: Mr. Speaker, I urge my Republican colleagues to stop playing politics with health care. Open your eyes and see the pain of America's working families.

SIEGEL: The repeal effort is headed nowhere, since the Senate is not likely to support it and the president has vowed to veto it. Nonetheless, during the debate, we've been hearing once again the major differences between supporters and opponents of the law, and it can be hard to make sense of it all.

BLOCK: So we've asked you to send us your questions. And here to help us answer some of them now is NPR health policy correspondent Julie Rovner. Hey, Julie.

JULIE ROVNER: Hey, Melissa.

BLOCK: And let's get started with, by far the most-asked question has to do with the Republican mantra that the health care law is job-killing. And in fact that is the title of the repeal legislation: Repealing the Job-Killing Health Care Law Act. A lot of our listeners, Julie, want to know, is the law in fact job-killing?

ROVNER: Well, the Republicans have put out this report that says that the law would kill, if you will, 650,000 jobs. But that statistic, which the Republicans say comes from the Congressional Budget Office, has been pretty thoroughly debunked, among others, by the group

It turns out that what the CBO actually said about job loss is that the law would allow people to stop working, probably because they would no longer be tethered to their jobs in order to get the insurance. So they could retire earlier, they could go off and start their own business. So it would produce a reduction in the number of people employed, but not because employers would fire people or not hire people. So there would be a smaller group of people employed.

Now, the CBO also said that there would be a reduction perhaps in low-wage workers because of the law, but they said that that would be small in all likelihood. And that's something that other analysts have agreed with.

BLOCK: Let's move on to a question from Dane Schumacher(ph) of Huntsville, Arkansas. He writes this. He says he's a full-time farmer there. He says he lives off the proceeds from farm sales and he earns less than $15,000 a year. And this is what he wants to know: Will I be required to purchase health insurance? If so, how in the world does the government expect me to afford to do so?

ROVNER: Well, in a word: No. People who earn less than 133 percent of poverty, and that's about $14,400 this year, will get Medicaid coverage which costs them nothing. Now, that's a big change. It used to be that to get Medicaid, you had to not only be poor but fit into a certain category. You had to be a child, or blind, or disabled. Under this new law, you simply will have to be low-income. So starting in 2014, if you are low-income you will be eligible for Medicaid.

BLOCK: But what if, say, he were over that threshold even by just by a little bit, would he have to buy health insurance then?

ROVNER: Not necessarily, there are several exemptions to the mandate. It turns out, if you don't earn enough to owe federal income taxes - and that's about $10,000 for an individual or about $18,000 for a couple - you don't have to buy insurance.

Also, if the lowest cost insurance policy would require you to pay more than eight percent of your income, you're also exempt from the mandate. So if you don't earn very much money but it's still too much to be on Medicaid, you will not have to buy health insurance under this law.

BLOCK: Julie, we got a question from listener Theresa Stallman West(ph) from Los Angeles. Here it is: A friend of mine works for a law firm in New York City. The owners of the law firm said that when the new health care law takes effect, they will just refuse to provide health insurance for their employees and accept the government's fine for not providing it. They said this will be cheaper than actually providing the required health insurance. And she wants to know, if this is true, wouldn't all companies do this?

ROVNER: This is a little bit confusing and I know everybody is confused. Right now, no employer has to do anything, has to provide health insurance for their workers. So they can stop providing insurance any time they want.

Under this law, the very smallest employers - those with fewer than 25 workers - actually get a tax credit to encourage them to provide insurance. Those with fewer than 50 workers don't have to do anything. They can if they want to. They don't have to.

Those with more than 50 workers don't have to provide insurance, but if they don't and their workers go into these new marketplaces called exchanges and they have low enough incomes that they will be eligible for a subsidy in those exchanges, then those employers have to pay what's called a Free Rider Penalty. It's $2,000 a worker. That's what this letter writer is talking about.

Now, there is some thought that for some larger employers it might be cheaper to give up providing insurance and put everybody into those exchanges, let them get their insurance. That's true. But there is evidence to the contrary, that employers won't do that. A, there's already a mandate like this in Massachusetts. That hasn't happened. In fact, the number of employers offering insurance has gone up.

The other thing we know is that people have surveyed businesses who say they - most of them plan to continue to offer insurance. It's a way to recruit and retain workers.

BLOCK: In a way, Julie, does this question spool back to the question about is the bill job-killing? Because you do hear about businesses who say if the threshold is 50 workers, I'm not going to hire that - 51st worker. I'm going to keep under that threshold so that I don't face this situation.

ROVNER: Well, that is one concern but also if they decide that it's cheaper to pay the penalty, not provide the health insurance, put the workers in the exchanges, then they could hire more people.

BLOCK: Julie, we have time for one last question and this one is from Dave Manley of Boston. Why does most of the current law not go into effect for several years? If the purpose of the bill is to expand and improve health care in the U.S. and reduce its cost, he wants to know, why the multi-year rollout?

ROVNER: Well, the cynical answer and the one we've been hearing from Republicans in the debate over the last few days is that for budgeting reasons they want, you know, the Congressional Budget Office looks at these 10-year windows. And, of course, if there's only six years of benefits, it will score less. It will look less expensive.

But there's a more nuts and bolts reason, too. And that's that we are moving this enormous, you know, ocean liner of the health care system and moving it a lot. And it affects every level of government, you know, every person who gets health insurance, every health insurer - really, every segment of the health care industry. And that takes a lot of doing. There are a lot of regulations to be written. There's a lot of details to be done.

So it really does take a long time to do this. Does it take four years? Possibly not, but it does take at least a couple of years. Obviously Congress wanted to get some of these, or at least the Democrats who wrote this, wanted to get some of these benefits out sooner so there will be something to show.

And that's why I think you've been hearing about a lot of these, you know, benefits that are already in effect about keeping kids on their parents' plans until they're 26, or the closing the Medicare drug benefit donut hole; things that are in effect now, because these big benefits are not going to go into effect until 2014.

BLOCK: Thanks to all our listeners for sending in questions. And Julie answers some more of them at NPR's health blog. You can find that at Julie Rovner, thanks so much.

ROVNER: You're so welcome.

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