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On the Third Hand: Confused

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EHealth (Nasdaq:EHTH), the parent of the eHealthInsurance.com health insurance exchange, has found that many small business owners have no idea how the Patient Protection and Affordable Care Act of 2010 (PPACA) is supposed to work.

Starting in 2014, PPACA is supposed to require businesses with 50 or more full-time workers to provide health coverage. Smaller employers are exempt from the requirement.

When eHealth polled 439 small businesses that bought health coverage from the eHealthInsurance.com site, it discovered that only two of the participating companies was big enough to be affected by the PPACA “play or pay” rule. But 34 percent of the employers thought they would face a PPACA coverage mandate.

Only 31 percent of the small employers understood that they were too small to have to worry about paying the PPACA “shared responsibility” penalty if they decided not to offer group health coverage.

About 68 percent said they want to continue to offer group health benefits in 2014 and 29 percent said they would consider dropping health benefits that year.

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On the one hand: PPACA haters have obviously whipped up hysteria about a demonic version of PPACA that doesn’t really exist.

On the other hand: EHealth or a think tank could have just as easily have put out a study examining the government and think tank analysts who make glowing, extremely confident predictions about what PPACA will do once it’s in effect. That version of PPACA doesn’t really exist yet, either.

On the third hand: The nice thing about PPACA is that the law itself does exist, and it seems as if the provisions will give the U.S. health finance system the kind of good, hard thump that sometimes gets a cranky old TV set back into working order. Whoever wins the presidential election in November (or, whenever Sandy lets us have elections), I’d really like him to explain how he’s going to give the health finance system the thump it clearly needs.

I wish we could focus less on demonizing PPACA and celebrating PPACA and more about doing the hard, boring work needed to get the system to be as efficient as the health care systems in other countries where the quality of care is fine, the cost of care is low, and getting sick doesn’t lead people to lose their homes.

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