The Treasury Department has published final regulations implementing the premium tax credit provision of the Affordable Care Act, trumpeting it as giving “middle-class Americans unprecedented tax benefits to make the purchase of health insurance affordable.”

In this document issued by the Treasury Department, there are three headings under which several bullet points or statements reside. I’ll take them one by one. My comments are in italics.

The Premium Tax Credit:

• Makes Coverage Affordable – Starting in 2014, millions of Americans will get help to purchase private health coverage through an Affordable Insurance Exchange (AIE). To make coverage affordable, the level of support is tailored to individuals’ needs. Besides the problem of semantics – what is “affordable” to policy-makers is an entirely different thing from what is affordable for someone making $40,000 a year – there is the logistical problem of the fact that, regulations or no, “Affordable Insurance Exchanges” don’t currently exist and many states have stopped trying to figure out how to create one while we wait to see if the Supreme Court will strike down the whole ACA or just parts of it, and what parts those will be.
• Provides a Substantial Benefit – The Congressional Budget Office estimates that, when the Affordable Care Act is fully implemented, individuals and families who qualify for assistance will receive premium tax credits of over $5,000 per year, on average. Well, full implementation of the ACA is questionable at best, even without the Supreme Court decision. Republicans have made it clear that they will do everything in their power to repeal, or at least dismantle, the law. Then there’s the “who qualify for assistance” part. If you make more than 400% Federal Poverty Level (FPL), which is $43,560 for an individual, $89,400 for a family of four, you’re screwed. And this is just the insurance PREMIUM we’re talking about – deductibles, co-pays, co-insurance, and uncovered costs are not included. Under proposed funding for single-payer healthcare, an individual could save more than 5,000 actual dollars (as opposed to a credit they will never see) and there would be no premiums, no co-pays, deductibles, co-insurance, and no uncovered costs for medically necessary test, treatments, or procedures.
• Builds on What Is Best in the Existing Health Care System – The Affordable Care Act includes crucial safeguards to ensure that coverage purchased on an AIE with the premium tax credits will supplement – not supercede – existing employer- and government-sponsored health programs. This allows Americans to keep the coverage they have. First, one might ask just what exactly is “best” in the existing system, but I don’t think an answer would be forthcoming, so I’ll move on to “coverage purchased on an AIE with the premium tax credits” – the thing they don’t tell you up front is that, according to their own calculations, a family of four with an income of $50,000 purchasing the mystical “benchmark plan” (which has yet to be defined in terms of the coverage it will provide) for $9,000 would be expected to pay roughly 6.7% of their income (or $3,570, almost $300 per month) before the tax credit would pay the rest. Again, where does that family that brings home $42,500 after taxes get the $3,570 for the premium and then additional money to pay co-pays, deductible, co-insurance and whatever percentage of costs the insurance doesn’t pay? Under single-payer, if one parent was working, they would pay $2,375 healthcare tax – no premiums, co-pays, deductibles, co-insurance or uncovered costs. As for keeping the coverage we have, who cares? It does me no good anyway.

• Includes Special Protections for Married Couples – The final regulations include a new, taxpayer-friendly rule aimed at addressing the concern that individuals who marry during the year could receive reduced tax benefits. Hmmm…”taxpayer-friendly”?? I guess, unless you happen to be a gay or lesbian taxpayer. Just another legal protection NOT extended to gay couples.

The next heading is “Key Facts About the Premium Tax Credit” – honestly, I’m getting so mad and discouraged by going through this thing point by point, that I’m just going to say that of the five “facts” listed, the third and the fifth are the most dangerous.

“Controls Health Care Costs By Encouraging Families to Choose More Cost-Effective Coverage – The amount of the premium tax credit is generally fixed based on a benchmark plan (which may be age-adjusted within ACA limitation), so families that choose to purchase coverage that is less expensive than the benchmark plan will pay less toward the cost of that coverage.” So don’t buy the bare bones benchmark plan, go for Really Crappy! Lower cost usually means higher deductibles, higher co-pays, less coverage, more rules (like pre-approval, network-only, etc.) – in other words, throwing whatever you pay down the toilet unless you get hit by a bus or your genetic predisposition towards heart attacks kicks in, but even then, be prepared for that $15,000 deductible!”

“Helps Families’ Cash-Flow by Covering Premiums Upfront” -Since many low- and middle-income families may not have sufficient cash on hand to pay the full premium upfront, an advance payment will be made by the Department of the Treasury directly to the insurance companies.This advance payment will assist families to purchase the health insurance they need.” This is one of the scariest parts of the ACA. Considering the historical misuse of Medicare and Medicaid funds for other purposes, do we really believe that there will never come a time when harassment calls will come from the insurance company demanding to be paid the amount they were supposed to be paid by the government? And there has already been legislation in Congress to require the taxpayer to pay any excess premium support that might have been overpaid. The potential for corruption and malfeasance seems unlimited. “…the health insurance they need.”?? No one needs health insurance – what we all need is health care. Then there’s the question of where the money for these premium tax credit payments will come from in the first place. Do we really believe the 112th or 113th Congress is going to approve funding such a thing? When they try to destroy Medicare and Medicaid almost daily? When they would cut every single socially responsible program in favor of a bigger Defense budget or no taxes on corporations or the top 1%? Seriously???

I will continue to say it. I know that his campaign and his handlers will continue to spin the ACA as the answer to our healthcare woes, but this mess is NOT what President Obama wanted. He is not singularly to blame and I will support him in every other way. But even though my respect for and belief in him is strong, I intend to do whatever I can to give him the proof he needs to chalk the ACA up to experience and say, “OK, Republicans – the People are in my front yard demanding I do better, so go ahead, repeal the ACA. We don’t need it – we’re going for single-payer!”

That’s why we need every single one of you at DUH. There can be no polite, timid request from 1,000 people. There must be thousands of ALL kinds and we must roar loud enough that the windows of Congress and the White House rattle! And a month later, we must shake the political pundits off their smug predictions by doing our jobs in the voting booths…no, BEFORE election day, we must make sure we have the 5 different kinds of I.D., the retina scan, the urine sample and whatever else the fascist governors trying to suppress our vote require so then we can shake their worlds by firing them all and electing people, no matter their party, who won’t be bought, who will represent us truthfully, and do what is best for the whole country, not just for themselves. Conservatives who are good with money, but also  wish to conserve human and natural resources. Liberals who are against war but who can also fight fiercely and strategically. Politicians of all kinds who pay more attention to the calls, emails, letters, and speeches of their constituents than they do to lobbyists, special interests, talk shoe hosts, and polls.

I keep coming back to John Lewis on August 28, 1963 – “We all realize that in order for any social, political, or economic change to take place in our country, it is the people, the masses, who must bring it about.” Let’s do it.