One of President Obama's architects of the historic healthcare reform, Tom Daschle, is warning that unless the still evolving "Obamacare" is instituted perfectly, Democrats could pay in the next three elections. "A lot of things have to go right for these changes to work," Daschle writes in a new book out October 12 about the two-year healthcare battle.
In his insider's account, Getting It Done: How Obama and Congress Finally Broke the Stalemate to Make Way for Health Care Reform, Daschle cites at least 10 huge hurdles in Obamacare that can trip up Democratic political hopes in 2010, 2014 and 2016, especially if the public continues to sour on the reform which the GOP has pledged to sideline if elected into House and Senate majorities. The potential for problems fall in three categories: higher premiums, a reduction in coverage and much higher taxes.
Daschle's top 10 political pitfalls:
1. Higher premiums. While he says that "there is little risk" that everyone's health insurance premium will go up, "it is unrealistic to expect that none of us will see any increases."
2. Preexisting condition gap. 2010 will see that children with preexisting conditions can't be rejected by health insurance companies, but adults won't get that benefit for another four years.
3. Shrinking Medicare payments to doctors. 2011 will see payments to Medicare Advantage plans frozen and payments to providers will increase at a slower rate as it becomes official policy to expect healthcare providers to become more efficient. Daschle says that Medicare Advantage users will get fewer "extras" and he warns that the Feds will have to keep an eye out for doctors who stop seeing seniors as a result.
4. Increased senior premiums. In 2011 more high-income seniors will start paying higher premiums. They will also get less of a subsidy for prescription drug coverage.
5. Cuts in Medicare Advantage. In 2012, Obama's reelection campaign year, Daschle says that "there will be some significant healthcare events this year that are not politically safe." Such as: Payments to Medicare Advantage plans will now be cut, not just frozen.
6. Mediare-cutting panel. Also in 2012, Obama will have to appoint a board charged with "tightening Medicare spending even more." Daschle concedes that "in an election year, the appointment of the board is sure to lead to a new round of overheated charges about what the board might to do seniors' care."
7. Medicare tax boost. Come 2013, Daschle reports that individuals earning more than $200,000 a year and couples earning $250,000 a year or more will see a boost in Medicare taxes, ironically called the "HI tax," short for hospital insurance tax. That tax will go from 1.45 percent to 2.35 percent In addition, he notes, there will be a brand new 3.8 percent tax for these folks on unearned income from investments.
8. Change in healthcare deduction. Also in 2013, the healthcare spending deduction will change. Where you can now deduct anything spent over 7.5 percent of your income, the new base will be 10 percent of annual income. Seniors get an extension on the 7.5 percent rate until 2017.
9. Employer tax. 2014 sees many of the major changes in healthcare reform. One biggie with political implications: If employers have more than 50 full-time workers and do not provide coverage, they will be fined $2,000 for each employee. What's more, if they provide coverage, but it's so expensive workers seek the outside option provided in Obamacare, the employers will have to pay $2,000 each or $3,000 for those that get a tax credit, whichever penalty is less.
10. Individual penalty. In 2016, with most of the reforms, in place, individuals who don't have health insurance will be fined $695 a year, or 2.5 percent of annual income, whichever is greater.
Daschle, whose tax troubles forced him to withdraw his nomination to be Obama's first secretary of Health and Human Services, urged Republicans and the public to give Obamacare a chance, just like others in the past gave to Social Security, Medicare, and the civil rights movement.
"The new healthcare law deserves the same chance. There is so much potential for good in every aspect of the law, and people will begin to see the good once the biggest reforms take effect. But this will only happen if we give the law enough time to show its full potential," he writes.