Making it work

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On Tuesday, the White House extended by one year the deadline for companies with more than 50 full-time employees to provide their workers with health insurance. The provision was due to go into effect Jan. 1 along with the rest of the Affordable Care Act. It requires employers to offer affordable coverage or pay a $2,000 to $3,000 penalty for each worker eligible for a federal subsidy to buy coverage in the new insurance exchange. In delaying implementation of the “employer mandate,” the White House acknowledged the requests of small-to-medium-sized employers for more time to adapt to the complex new requirements and to sort out the business implications, from hiring policies to financial obligations.

The delay of enforcement is a significant concession to the 6 percent or so of small employers that currently do not offer health insurance. As important, it demonstrates the continuing adjustments, the flexibility, that will be crucial to implement the overhaul legislation and the transition to a more effective and efficient health-care system.

At a cost of more than $2 trillion a year, the nation’s health-care system is hugely expensive. The structure is proving increasingly inefficient, too. To varying degrees, public and private employers insure their own workers. The government shoulders coverage for the elderly, the disabled and the indigent. The result is legions of Americans (some 50 million currently) left out of the employer- and government-sponsored coverage. The cost of care for the uninsured when they do fall sick filters through the entire system, fueling personal bankruptcies and raising health-care and operating costs for businesses and governments.

Still, it is clear from previous stabs at an overhaul that the employer-based system remains overwhelmingly popular, in spite of the glaring shortcomings. Such is the political and cultural reality. Unfortunately, it also limits feasible options to make basic health coverage universally accessible to all citizens.

The admirable fact about the Affordable Care Act is that it takes the challenge head on. Since the nation chooses to tie health coverage to employment, the employer mandate aims, rightly, to expand the reach of coverage. It does so within the market framework the nation prefers: through employers and with private insurance companies competing for business in health exchanges. Employer penalties for not offering health benefits likely would fall well below the annual cost of premiums, which averaged $5,615 in 2012 for single coverage in employer-sponsored plans.

To be sure, the reform law is complicated. It is necessarily so. The health system is massive, and its parts are closely intertwined. But the delay should not be a pretext for employers to play the angles, looking for advantage that would deny adequate insurance to the many uninsured workers.


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