Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
"There is a lack of trust already, to begin with," Rep. Diane Black (R-Tenn.) said Wednesday morning. "People don't have a lot of confidence and now we're about to give them an unprecedented amount of authority to get information that is highly personal."
The IRS is, aside from Heath and Human Services, arguably the most important agency in implementing the Affordable Care Act. There are 47 separate Obamacare provisions that require involvement from the agency. The IRS is tasked with implementing the law's required purchase of health coverage, checking whether millions of Americans are in compliance.
The IRS has so much work to do on the Affordable Care Act that it's come up with an incredibly detailed organization chart, published last year in a Government Accountability Office report.
As you can see here, there are essentially four big buckets of work that the IRS divides its Obamacare work into. The agency needs to figure out who is eligible for what tax credits to purchase health insurance, a determination based on income.
"The IRS’s most substantial implementation effort relates to the delivery of hundreds of billions of dollars in premium assistance tax credits that will help millions of American families afford health insurance starting in 2014," IRS Commissioner Douglas Shulman testified before Congress last summer.
The agency also has to come up with a form to figure out who carries health insurance and who has decided to forgo the option. While this paperwork doesn't exist yet, the form that Massachusetts has used for a few years now, gives a sense of what the agency needs to work on on that front.
The agency also has to do outreach on the health law's mandate; if it's going to start docking Americans' tax refunds for not carrying health insurance coverage, it wants to give them a heads up before hand.
Will this current scandal make it harder for the IRS to implement all of the health law provisions that it has a hand in? It's hard to say. Congress could refuse to provide the additional $440 million that the Obama administration has asked for in IRS health law implementation funds.
But that wouldn't be any different from any other year. Congress has repeatedly declined the administration's requests for additional funding. The Obama administration has then pulled funding out of a $1 billion general implementation fund.
The Obama administration requested $440 million for the IRS to process the premium tax credits and, even before this scandal, it wasn't likely to get Congress' stamp of approval. The administration was not going to get the funds it wanted for Obamacare, regardless of what's happening in Washington right now. It hasn't for years and this Congress - which is about to take its 37th repeal vote Thursday -- isn't likely to change its mind any time soon.
As to whether this could lead to lower compliance with the individual mandate if fewer Americans feel comfortable sharing their health insurance status with the federal government, that could, in theory, pose a problem. If lots of people opt-out of the health care law that obviously lessens the reach of the health care law. If lots of young healthy people opt-out, that could lead to a spike in rates.
This would have to be a pretty wide-scale phenomena, however, to impact the health law's success. We're talking about hundreds of thousands of uninsured Americans deciding against sharing their insurance status with the federal government, not just a handful.
At most, the IRS is probably in for an increased amount of oversight as it moves forward on implementation of the Affordable Care Act, more questions about the data it will collect and how it will be used. Aside from that, there's not much Congress can do to stand in the agency's way that they have not done before.
KLIFF NOTES: Top health policy reads from around the Web.
Health reform removes protections for thousands who identify as Native American. "Under President Barack Obama’s health care overhaul, DeRouen and tens of thousands of others who identify as Native American will face a new reality. They will have to buy their own health insurance policies or pay a $695 fine from the Internal Revenue Service unless they can prove that they are 'Indian enough' to claim one of the few exemptions allowed under the Affordable Care Act’s mandate that all Americans carry insurance." The Associated Press.
Sorry, White Castle fans: The chain says health care costs are slowing its expansion plans. "White Castle Management Co., a closely held chain that doesn't franchise any of its 406 restaurants, says it is significantly slowing its growth plans in light of rising health-care and other costs. The burger chain plans to open two or three new restaurants this year, down from about a dozen three years ago, and five in both 2011 and 2012, company spokesman Jamie Richardson said." Julie Jargon in the Wall Street Journal.
An Oregon insurer may cut its rates after seeing what the competition plans to charge on the health exchange. "At least one health insurance company may lower rates -- following the release of proposed prices on Oregon's new health insurance exchange. The state has given all insurers until Friday to make price adjustments." Kristian Foden-Vencil at Oregon Public Broadcasting.