Did the Republicans really win the health care reform battle?

A strong case can be made that the Republicans have already essentially accomplished much their agenda with regard to health care reform. If we look at what is really happening on ‘Main Street’ and not in DC and ignoring how the law is supposed to work we see:

• No enforcement against businesses for ACA requirements
• Growing number of tax professionals who do not comply with ACA requirements for self-reporting of penalties
• The president’s order to government agencies to minimize the impact of ACA
• A government option remains as a safety net
• Growing number of non-compliant health insurance choices in the interstate health insurance market
• Health plan sponsors may modify coverage based on religious grounds
• Taxpayers may ‘forum shop’ on health care law and choice of insurance options based on their own unrestricted choice of residence
• IRS admission that it does not have legal authority to collect ACA penalties other than to withhold future refunds
• IRS announcement that it won’t fail to process or withhold refunds from taxpayers who refuse to comply with ACA self-reporting.

The end result, I argue, is that we have a voluntary safety net program that can be utilized but that nobody is forced to use.

Almost every day I receive calls from individuals and business owners telling me their problems with ACA. In response, I list a range of options that are available to them. They don’t always like the options I present; that’s not something I can control.

I typically discuss risk management, asset protection, choice of residence (insurance law issues), and tax planning. The response is something like “all I really want is cheap insurance that covers everything”. Sorry about that. But don’t say that ACA is the only problem in your way.

No law – Democratic or Republican – can make health care options palatable to reasonable Americans. None of this discussion or the news this week addresses the core issue that health care is too expensive and increasing at an unsustainable pace. None of this addresses the tough but inevitable questions surrounding rationing of health care.

My point is simply that freedom of choice is a core Republican principle. That’s where we are today, regardless of what the law says.