Thursday, January 18, 2018

Editorial: Improving heath care reform

Americans have much to look forward to as the Affordable Care Act goes into full effect in January. But major legislation never passes without political compromise, ensuring that fixes and revisions will be required, just as has happened to Medicare, Medicaid and Social Security. President Barack Obama borrowed heavily from former Gov. Mitt Romney's health reforms in Massachusetts and overlaid a new system atop the established private insurance market. That made the law far more complex and increased the likelihood that changes would have to be made. Now that it's just months from full implementation, the following are among the tweaks needed to ensure more people get health coverage.

Close the bare-bones health plan loophole

An important goal of the ACA was to nearly eliminate health insurance that failed as a true medical safety net, where people would get sick or injured and find out their coverage was lacking.

But a glitch in the law may allow large employers to offer employees coverage that can barely be called insurance. Beginning in 2014, employers with 50 or more full-time employees must offer affordable health coverage or pay a penalty of $2,000 per worker, minus the first 30 workers. Large employers must offer "minimum essential coverage," a term so broadly defined that it appears to be satisfied with plans that cover little more than preventive services, costing as little as $50 per month per employee. Employees who want more coverage could seek it through an exchange, and if they qualify for a federal subsidy to help cover the cost, their employer is penalized $3,000. But some employers appear willing to gamble their low-wage workers won't do so since it would mean additional cash out of their pocket as well. This needs fixing.

Adjust the "full-time employee" definition to minimize evasion

Part-time workers may soon find that the ACA is harming their ability to work a desirable number of hours. In a disturbing trend, workers at chain restaurants, retail stores and even part-time professors at college campuses are having their weekly hours shortened to under 30 per week so their employers can avoid the health insurance mandate. The ACA defines a full-time worker as on the job an average of 30 hours per week or more.

Large employers who are capping hours at 29 per week to avoid the ACA should not get away with it. There needs to be a secondary formula for determining what constitutes a large employer that includes the part-time workforce in some fashion, at least for the purposes of the health insurance mandate and assessing the penalty, if not for providing coverage.

Clarify that states may use expanded Medicaid funds for private insurance

After the U.S. Supreme Court made expanded Medicaid under the ACA optional for the states, some conservative lawmakers objected to adding participants to traditional Medicaid. To overcome this resistance the Obama administration has said it will grant waivers to states that want to use expanded Medicaid funds to buy comprehensive private insurance for low-income people, as long as the costs are the same.

A Florida Senate-passed plan would have needed such a waiver. But the Florida House refused to go along. Florida House Speaker Will Weatherford, R-Wesley Chapel, claimed the waiver might not come through — one of many excuses he made to reject $51 billion in expanded Medicaid funds over 10 years that would have extended health coverage to nearly a million poor adults. The law needs to eliminate this excuse.

Provide federalsubsidies to adults under the federal poverty line to buy private health insurance on the exchanges

The poorest Americans in states that reject expanded Medicaid are caught in a bind. They will have to pay more for private health insurance on the online exchanges than people far wealthier. That's because the ACA provides federal subsidies only to people earning between 100 and 400 percent of the federal poverty line (for individuals 100 percent is $11,490 in 2013; 400 percent is $45,960). The law anticipated that adults with incomes under 138 percent of the federal poverty line would be covered by expanded Medicaid. But in places like Florida where Medicaid expansion has been rejected, a change is needed so these adults can also receive federal subsidies.

These recommended revisions would close problematic loopholes and coverage gaps. Republicans in Congress are resisting any efforts to better Obama's signature domestic achievement, holding out instead for a wholesale repeal of the ACA. It is a virtual obsession in the Republican-controlled House, which has voted for a full or partial repeal 37 times. But these changes would serve their constituents without costing any additional tax money. Florida Gov. Rick Scott, a fierce opponent of the ACA, was willing to accept expanded Medicaid funds for the good of Floridians. Republicans in Congress should make the same calculation and end their obstruction and help make the law better.


Another voice: Self-dealing by nursing home owners threatens patient care

The outsourcing of logistical support services, which became commonplace in the U.S. military in the 1990s and later was adopted by state prison systems, has now come to dominate the nursing home industry. And while nursing homes, unlike the military...
Updated: 10 hours ago
Editorial: Making illegal sewage discharges legal is wrong answer

Editorial: Making illegal sewage discharges legal is wrong answer

Three years into a crisis with its sewer system, St. Petersburg has a dandy new idea for dealing with the environmental fallout of dumping dirty water into the aquifer. Instead of committing to banning the outlawed practice, a consultant suggested th...
Updated: 9 hours ago
Editorial: Tighten substitute teacher rules in Hillsborough

Editorial: Tighten substitute teacher rules in Hillsborough

A substitute teacher at a Plant City elementary school berated a class of fourth graders — and then the school principal. Another compared a student to a stripper. Others were caught napping, hitting children, making sexual remarks, giving students b...
Updated: 11 hours ago
Editorial: Balancing the playing field for workers’ compensation

Editorial: Balancing the playing field for workers’ compensation

For the longest time, injured workers in Florida were basically at the mercy of the whims of employers to treat them fairly. A 2003 law aimed at reducing the cost of workers’ compensation coverage for businesses had the desired impact, but it also di...
Published: 01/16/18

Another voice: Why just Florida?

Cynicism has always been a part of politics, but rarely are politicians so brazen and self-serving as President Donald Trump and his interior secretary, Ryan Zinke, have been over the past week. First they announced a new offshore drilling plan that ...
Published: 01/16/18
Editorial: King’s legacy still relevant in digital age

Editorial: King’s legacy still relevant in digital age

Today’s holiday honoring the legacy of Dr. Martin Luther King Jr. couldn’t be more timely. At a moment when the nation’s civic dialogue is choking on personal and political division, it is hard to remember an earlier time when role models were role m...
Published: 01/15/18

Another voice: 38 minutes of fear in Hawaii

In 1938, Orson Welles panicked the nation with a false alarm about a Martian invasion in the radio broadcast The War of the Worlds. That was farfetched, of course. But what happened on Saturday, sadly, was not so hard to imagine — or believe.Authorit...
Published: 01/14/18
Updated: 01/16/18
Editorial: Florida’s chance to make it easier to restore civil rights

Editorial: Florida’s chance to make it easier to restore civil rights

As it has for decades, Florida stubbornly clings to an inhumane, inefficient and indefensible system of justice that permanently sentences more than 1.5 million residents to second-class citizenship. This state automatically revokes the right to vote...
Published: 01/13/18
Editorial: Speak out against Trump’s vulgar remarks

Editorial: Speak out against Trump’s vulgar remarks

President Donald Trump’s vulgar outbursts during a White House meeting on immigration are racist and indefensible no matter how he parses them. They are not presidential, they undermine U.S. foreign relations and they do not reflect America’s values....
Published: 01/12/18

Editorial: Pinellas commission stands up for accountability

The Pinellas County Commission has gotten the message that it should not be a rubber stamp. Commissioners sent a clear signal this week they will demand more accountability of local agencies by refusing to approve nominees for the board for CareerSou...
Published: 01/11/18
Updated: 01/12/18