WASHINGTON — For a law whose admirable goal is to ensure better health care at lower cost for all Americans, the Affordable Care Act has come under remarkably varied and persistent attack.
The latest volley concerns the obscure issue of how to apply a penalty on individuals and businesses that fail to obtain health insurance, and who thereby put all the rest of us on the hook for big medical bills.
This penalty, which is intended to encourage the classic conservative value of personal responsibility, will be collected as part of annual tax filings, a reasonable and efficient method that’s only objectionable to those whose real objection is to the whole concept of health care reform.
From a purely technical standpoint, the IRS is the appropriate agency to collect these payments, since the Supreme Court has declared the penalty assessed on individuals is a tax. And it certainly can be viewed that way, since the money raised will help offset the public cost of uninsured care.
But even if not a tax, the uninsured penalty joins dozens of other nontax payments the federal government, as well as states and localities, routinely collect without controversy on their tax forms, from underpayment penalties to presidential campaign contributions to camping fees.
Since no one likes paying taxes, tax collectors are never popular — and the IRS is no exception. The extra scrutiny many conservative groups seeking nonprofit status were subjected to in recent years, though many liberal organizations were caught up in the same dragnet,has raised legitimate concerns that are being addressed.
That apparent administrative error on the part of the IRS has absolutely no bearing on the revenue agency’s ability to fairly collect penalties from individuals and businesses trying to duck their health care responsibilities.
No one will go to jail for not buying health care insurance. In fact, the ACA specifically softens the enforcement powers of the IRS in this area, forbidding the agency to seek criminal penalties or obtain liens or garnish wages in pursuit of the penalty on uninsured individuals.
And for reasons ranging from too little income to religious belief and practice, individuals can obtain an exemption from the requirement to obtain insurance and thus from any penalties.
Of course, most uninsured people want to be insured. The problem for them has not been a lack of coercion, but a lack of opportunity.
By setting up online insurance marketplaces where consumers can easily compare the cost and quality of insurance across a range of companies; offering subsidies to help buy coverage to families making up to four times the poverty level; and expanding Medicaid to cover more low-income households, the ACA makes more dependable health care available to more Americans than at any time in our history.
What’s ironic about conservative opposition to IRS involvement in administering the Affordable Care Act is that it’s only necessary because the basis of the law is individual, rather than community, responsibility.
The individual mandate to obtain health insurance originated with the conservative Heritage Foundation and was endorsed by former conservative House Speaker Newt Gingrich.
As important a step toward universal health care coverage as the ACA represents, the simpler, more equitable and more efficient solution would have been Medicare for all.
By expanding to the rest of the nation a public system that already serves 50 million Americans, we would guarantee complete coverage and eliminate the cost and complication of private insurance. Medicare’s administrative costs are only 2 percent of revenues, whereas private insurance averages 16.7 percent.
And if health care was provided as a right and paid for out of general revenues, as it is in most other developed countries, there would be no need for the IRS to check up on anyone’s health insurance status.
William Rice is a policy consultant with Americans for Democratic Action.