Second Opinion: How Will the Feds Enforce the Individual Mandate?

Second Opinion: How Will the Feds Enforce the Individual Mandate?

Photo by Megan Burks

Miccilina Piraino says the Affordable Care Act's individual mandate is an overstep and unfair to those with limited means to obtain health insurance. She wants to know how the government plans to enforce the requirement to buy health insurance.

Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.

The Question: How will the government find homeless and undocumented people to help them get covered and enforce the individual mandate?

Miccilina Piraino moved to San Diego from the East Coast nine years ago. She pays for basic health coverage through her employer but does not support the Affordable Care Act’s individual mandate, which says all Americans who are able must have health insurance starting next year. She said the provision is an overstep and unfair because access to health care isn’t equitable.

Video by Megan Burks

Here’s Piraino’s question:

“My question and concern is wondering how this program is going to be framed so it is fair to all American people and not just a certain part of the population. How are they going to enforce it so that it’s across-the-board fair to everyone and find those who are either homeless or illegals or have no coverage whatsoever? Are they going to find them and help them, as well as enforce this program?”

The Takeaway: The feds will enforce the individual mandate through taxes, but the requirement to buy health coverage does not apply to everyone.

The individual mandate does not say every person in the United States must get covered. It lays out exemptions for some groups, including members of Native American tribes, certain religious groups, incarcerated individuals, undocumented immigrants and people whose earnings are below the threshold for filing taxes.

feature_inline-second_opinion500Tax filings are the only way the feds can check if you’re buying health coverage. They’re not going to go after people who are living in the shadows, so to speak.

So, homeless and undocumented individuals do not have to get insured. (People living in the country illegally actually aren’t allowed to participate in the new insurance exchanges and Medi-Cal expansion.)

But that doesn’t mean the Affordable Care Act leaves out the homeless altogether. Before the law, Medi-Cal was really only available to families. Starting next year, childless adults can also get coverage that way. So now more homeless people will qualify for regular coverage – not just last-resort treatment in the emergency room.

Homeless services agencies, including Father Joe’s Villages, have been trained to educate and enroll their clients in new health coverage options.

The Orders: Unless you’re exempt or willing to pay a fine, get covered.

Obamacare begins to make the health system more equitable, but in answer to Piraino, some people are still left out.

For those who aren’t exempt and don’t yet have insurance, you have until March 31 to pick a plan.

Check out last week’s Second Opinion: Will Obamacare streamline care for disabled people?

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Megan Burks

Megan Burks

Megan Burks is a reporter for Speak City Heights, a media project of Voice of San Diego, KPBS, Media Arts Center and The AjA Project. You can contact her directly at meburks@kpbs.org or 619.550.5665.

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26 comments
Mark Giffin
Mark Giffin

They are going to be absorbed through the expansion of Medi-cal and the outreach push.
County social services have and are gearing up for this

Mark Giffin
Mark Giffin subscribermember

They are going to be absorbed through the expansion of Medi-cal and the outreach push.
County social services have and are gearing up for this

Bill Bradshaw
Bill Bradshaw

Megan, since "opinion" is in the headline for this story, I guess I can't complain too loudly about you inserting yours into what I thought was going to be a news article, but when you say "Obamacare begins to make the healthcare system more equitable" you might want to check with a few young and healthy people who are already substantially subsidizing my Social Security and Medicare through their taxes, to see what they think about this program, which may double their health insurance costs.

Bill Bradshaw
Bill Bradshaw subscribermember

Megan, since "opinion" is in the headline for this story, I guess I can't complain too loudly about you inserting yours into what I thought was going to be a news article, but when you say "Obamacare begins to make the healthcare system more equitable" you might want to check with a few young and healthy people who are already substantially subsidizing my Social Security and Medicare through their taxes, to see what they think about this program, which may double their health insurance costs.

mlaiuppa
mlaiuppa

If you're caught without a seat belt or no car insurance, you get slapped with a big fine on top of everything else.

I imagine it will be the same with the healthcare mandate. Get caught without healthcare and you'll not only be paying the hospital and dr bill, you'll get a nice big fine too.

mlaiuppa
mlaiuppa subscriber

If you're caught without a seat belt or no car insurance, you get slapped with a big fine on top of everything else.

I imagine it will be the same with the healthcare mandate. Get caught without healthcare and you'll not only be paying the hospital and dr bill, you'll get a nice big fine too.

David Cohen
David Cohen

The article does not explain how it will be enforced, the headline notwithstanding.

Megan Burks
Megan Burks

Hi Bill, I was referring to the fact that the Affordable Care Act will offer Medi-Cal coverage to folks who previously had no access to health insurance. It is a fact that the law begins to fill that access gap.

It has been a goal of mine to answer any question that comes my way - regardless of which side of the political spectrum it comes from - as fully and factually as I can. That is why you'll see that this week I put a woman who doesn't support the Affordable Care Act on the front page of voiceofsandieg.org, kpbs.org and speakcityheights.org and aired her concerns about the law on KPBS radio and television. This is not the first week I have featured participants who don't like the Affordable Care Act.

Randy Dotinga
Randy Dotinga

You mean young and healthy people who already get insurance through their jobs? Or those who are on the independent market only? Or both?

And how will the system potentially double their health insurance costs? Does that number account for the option of catastrophic care?

And what about young and unhealthy people on the independent market who currently have no option other than ultra-expensive coverage or no coverage?

David Cohen
David Cohen subscriber

The article does not explain how it will be enforced, the headline notwithstanding.

Megan Burks
Megan Burks author

Hi Bill, I was referring to the fact that the Affordable Care Act will offer Medi-Cal coverage to folks who previously had no access to health insurance. It is a fact that the law begins to fill that access gap.

It has been a goal of mine to answer any question that comes my way - regardless of which side of the political spectrum it comes from - as fully and factually as I can. That is why you'll see that this week I put a woman who doesn't support the Affordable Care Act on the front page of voiceofsandieg.org, kpbs.org and speakcityheights.org and aired her concerns about the law on KPBS radio and television. This is not the first week I have featured participants who don't like the Affordable Care Act.

Randy Dotinga
Randy Dotinga memberauthor

You mean young and healthy people who already get insurance through their jobs? Or those who are on the independent market only? Or both?

And how will the system potentially double their health insurance costs? Does that number account for the option of catastrophic care?

And what about young and unhealthy people on the independent market who currently have no option other than ultra-expensive coverage or no coverage?

Randy Dotinga
Randy Dotinga

Not a good idea if you end up in an accident and need care immediately or if you have some other type of immediate medical crisis. Waiting until a crisis to buy coverage might work if you have some sort of chronic condition, but even then you'd have to deal with the acute phase without coverage.

David Cohen
David Cohen

As I understand it, there will be insurance coverage information requested on personal income tax forms, and enforcement of the tax/penalty will be limited to reducing a refund.

Randy Dotinga
Randy Dotinga memberauthor

Not a good idea if you end up in an accident and need care immediately or if you have some other type of immediate medical crisis. Waiting until a crisis to buy coverage might work if you have some sort of chronic condition, but even then you'd have to deal with the acute phase without coverage.

David Cohen
David Cohen subscriber

As I understand it, there will be insurance coverage information requested on personal income tax forms, and enforcement of the tax/penalty will be limited to reducing a refund.

Bill Bradshaw
Bill Bradshaw

Randy, my answer is "both". Increasing health care costs for young and healthy is the very foundation of how they made the numbers appear to jibe when selling the program to the public. We'll see whether my "double" is hyperbole or accurate. At this point you don't know, I don't know and the government sure doesn't know how this will end, but one thing is obvious: The ACA did NOTHING to lower the cost of specific medical procedures, tests, malpractice insurance, hospital beds or anything else that makes our health care the most expensive in the world by a mile. And the mandate to cover a lot of stuff people won't use is adding costs as well. Someone will pay, and the likely candidates are the young and healthy.

By the way, where is this "catastrophic care" option permitted under ACA?

James Weber
James Weber

Catastrophic coverage in the marketplace will only be available to people under 30 or those with a hardship exemption.

Bill Bradshaw
Bill Bradshaw subscribermember

Randy, my answer is "both". Increasing health care costs for young and healthy is the very foundation of how they made the numbers appear to jibe when selling the program to the public. We'll see whether my "double" is hyperbole or accurate. At this point you don't know, I don't know and the government sure doesn't know how this will end, but one thing is obvious: The ACA did NOTHING to lower the cost of specific medical procedures, tests, malpractice insurance, hospital beds or anything else that makes our health care the most expensive in the world by a mile. And the mandate to cover a lot of stuff people won't use is adding costs as well. Someone will pay, and the likely candidates are the young and healthy.

By the way, where is this "catastrophic care" option permitted under ACA?

James Weber
James Weber subscriber

Catastrophic coverage in the marketplace will only be available to people under 30 or those with a hardship exemption.

Jim Jones
Jim Jones

If you end up needing intimidate triage it will be done for you, and you will have time to shuffle your assets to protect them when the bill comes due, which you can ignore and bankrupt or do time payments that will likely be cheaper than the insurance would have been.

Part of shuffling assets is a change in marital status, which allows you to sign up for obamacare at that point, to cover the "acute phase". There are a few other ways to get obamacare out of the sign up cycle, most designed to serve the public trough feeders, but some the middle class can make use of.

Of course, we still don't know a lot about what obamacare will really bring, the projections that it was based on were written in the sunday comics, and it will either skyrocket premiums or collapse, and I am betting on collapse once the true costs materialize (which will be after the next election cycle, so the dems that supported it can try to escape responsibility for it for a while)

David Cohen
David Cohen

James--If that is intended as a reply to me, it doesn't. All I did was explain the enforcement mechanism, as I understand it.

James Weber
James Weber

Isn't the current penalty/fine $95 for the year? Hardly incentive to buy an expensive Cadillac insurance policy if you are young and healthy. Because there are no pre-existing conditions, you can wait until you get sick to buy coverage.

Jim Jones
Jim Jones subscriber

If you end up needing intimidate triage it will be done for you, and you will have time to shuffle your assets to protect them when the bill comes due, which you can ignore and bankrupt or do time payments that will likely be cheaper than the insurance would have been.

Part of shuffling assets is a change in marital status, which allows you to sign up for obamacare at that point, to cover the "acute phase". There are a few other ways to get obamacare out of the sign up cycle, most designed to serve the public trough feeders, but some the middle class can make use of.

Of course, we still don't know a lot about what obamacare will really bring, the projections that it was based on were written in the sunday comics, and it will either skyrocket premiums or collapse, and I am betting on collapse once the true costs materialize (which will be after the next election cycle, so the dems that supported it can try to escape responsibility for it for a while)

David Cohen
David Cohen subscriber

James--If that is intended as a reply to me, it doesn't. All I did was explain the enforcement mechanism, as I understand it.

James Weber
James Weber subscriber

Isn't the current penalty/fine $95 for the year? Hardly incentive to buy an expensive Cadillac insurance policy if you are young and healthy. Because there are no pre-existing conditions, you can wait until you get sick to buy coverage.