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Group health coverage is 'Obamacare'

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One of the strangest things I’ve seen in this strange week is people making fun of Donald Trump for complaining that “Obamacare” will hurt his company’s employees.

I haven’t gotten the impression that he spends his days and nights curled up with printouts of Health Affairs.

Related: Trump and Clinton squeeze ACA and Medicare into debate

But, at the same time, the people mocking Trump for saying that Obamacare will hurt his employees are using that word in what I think is a misleading way, just because they enjoy making fun of him.

I think calling the law “Obamacare” is wrong, to begin with, because we never call Medicare or Medicaid “Johnsoncare,” or the Americans with Disabilities Act “Bushfair.”

And, if anyone’s name should be on the ACA, then, for good or for ill, it probably should be Harry Reid. He might have been the only elected official who had much of a chance to look at the final version of the text before the Senate voted on it.

But, aside from that, one of the serious problems with use of the term “Obamacare” is that it’s often hard to figure out what people think they’re talking about when they use the term.

Do they think they mean the two-law Affordable Care Act package consisting of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010, including the tanning salon tax provision, and the various preventive health funding measures? If so, are they really burning mad about the ACA money spent on fighting flu?

Do they think they only mean the Affordable Care Act coverage expansion provisions, including Medicaid expansion?

Do they think “Obamacare” refers solely to the ACA public exchange system and exchange coverage?

I think typical Republican critics of the ACA outside of the insurance community are, like most civilians, hazy about exactly what’s in the law. But they generally seem to be using the term “Obamacare” to refer to all of the ACA package, from the first character to the last. They have a fervent desire to repeal the whole thing.

If Trump was using the term in that way, then the term certainly includes the kinds of group major medical plans that Trump-affiliated companies offer. Because of the ACA, he has to worry about employee counting, figure out exactly what entities he has to include when coming up with full-time equivalent totals, and make sure that someone handles such things gets the 1095-C’s and summaries of benefits and coverage out.

Related: Experts worry about IRS pitfalls

It’s possible that Trump was wrong when he said that Obamacare will lead to a dramatic increase in his own employees’ health coverage costs. But it also seems wrong for his critics to say that the only people who have Obamacare are individual exchange users.

And, even if large-group premiums and underlying medical cost trends appear to be reasonable stable, how do we really know what’s going on with large-group administrative costs?

Given all of the recent frantic employer efforts to count employees and cope with wave after wave of federal benefits-related audits, it could be that total large-group benefits costs are rising considerably faster than major medical premiums.

Related:

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Federal agencies pan PPACA employee counting rules

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