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It’s Not So Funny Now


Back when the US Congress was debating the Affordable Care Act (aka Obamacare) a lot of us complained that it would mix the efficiency of FEMA with the compassion of the IRS.

That turns out to be not so funny now that the law has been passed and is starting to take effect. It turns out that the Internal Revenue Service will be the main enforcement and implementation agency for the act.

Which at the time I pointed out was not about health care or controlling costs, but was about control.

Byron York: IRS scandal raises fears about enforcing Obamacare

The IRS is critical to Obamacare. The structure created by the Affordable Care Act requires the government to know about both the health care coverage (or lack of it) and the financial resources of every American. The IRS, which already knows the latter, was the only agency with the reach to do the job.


A look at the text of the health care law reveals that much of it consists of amending the Internal Revenue Code to give the IRS more power. When Obamacare goes fully into effect in January, every American will have to prove to the IRS that he or she has “qualifying” health coverage, meaning coverage with a list of features approved by Health and Human Services Secretary Kathleen Sebelius. That will be done by submitting a document to the IRS, something like a W-2, to confirm coverage.


The IRS will also decide who is, and who is not, eligible for Obamacare’s subsidies. The law authorizes the IRS to share confidential taxpayer information with the Department of Health and Human Services for the purpose of determining those subsidies. And since subsidies don’t just apply to a relatively small number of the nation’s poorest citizens — under the law, they can go to a family of four with a household income of nearly $90,000 — they will affect a huge segment of the population.

So now, the federal government will be in your business, literally. The IRS will have a tremendous amount of control over our lives on a daily basis.

In addition, the IRS will keep track of even the smallest changes in Americans’ financial condition. Did you get a raise recently? You’ll need to notify the IRS; it might affect your subsidy status. Have your hours been reduced at work? Notify the IRS. Change jobs? Same.

All of this will be monitored and controlled by an agency that admitted on Friday that some of it’s employees probably violated federal law by selecting who to audit based on political affiliations and leanings. An amazing number of individuals and organizations that were critical of the current Administration and government operations were selected for audits or had their applications for designation as non profit organizations delayed while others were quickly approved. No one yet knows how far up into the Administration this scandal goes, but it clearly is much higher than a few low level employees at a local office in Ohio.

I don’t know about you, but I’m very nervous about how this supposed healthcare law is going to unfold. The opportunities for corruption and political abuse are far too great for any agency of the government to be entrusted with. This goes beyond the current Administration because once this President is gone, the law will still be there. I see this in the same light as I do the PATRIOT Act. Or the RICO statute. They are all broadly sweeping laws that give federal authorities a lot of power with little oversight. We’re seeing that now as both RICO and the PATRIOT Act are being used in ways that the people who wrote it, voted for, and signed it, never foresaw. Broad, sweeping laws designed to deal with a “crisis” stay on forever and are used in ways never intended when they were passed.

I see no reason to believe that the Affordable Care Act will be one bit different.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.