Rep. Nancy Pelosi famously said of the Patient Protection and Affordable Care Act that Congress would “have to pass the bill so you can find out what is in it.” One finding last week made her remarks prophetic.
A recent discovery is that of a smoker’s penalty in the act. The penalty would add as much as $5000 to a smoker’s annual health insurance premium.
For the record, that’s about 20% of adults.
Such penalties might very well persuade many smokers to kick the habit, but it would have the more immediate effect of pricing many of them out of the private health insurance market. In turn, they would be driven to state exchanges—along with new part-time/former full-time employees and those whose companies just dropped health insurance altogether.
Experts are also talking about an obesity penalty. One state—conservative Alabama—already has such a penalty for state workers. Alabama’s penalty, however, is relatively modest, at about $25 per month. One can imagine a federal penalty being much higher, perhaps driving these folks to state exchanges, as well (which could be the point).
While such penalties might benefit the targeted folks, there is that old fact that most Americans simply don’t like being told what they must do, especially if they’re told not to do something. That is, most Americans value liberty to some degree.
But this is the folly of expanding the federal role in health care. When the national government heavily governs—or even provides—health care, then anything that has any relation to health is the purview of that central body.
When it comes to health care, that means just about anything.
The government will care how individuals live their lives because the state is footing the bill for health care. So when they have to cut costs, one measure is to restrict liberty, even though the fact that individuals may not pay much, if anything at all, for their health coverage may actually incentivize them to make unhealthy choices. When individuals foot the bill for their own care, they are more likely to make economizing decisions about their lifestyles (note that most of the country is on a third-party payment system, so few Americans know what their care really costs).
At any rate, as the ACA takes hold, expect more surprising moves from the feds, especially if state exchanges are flooded (perhaps overwhelmed) with new customers. With greater control over health care, the state will have a greater say in your personal decisions.