<p>TatinG: Nope, not at this time. They have zip, zero, nadda enforcement authority.</p>
<p>(This info is per Dr. Radio which is a satellite station that broadcasts our of NYU Langone Medical center. They have a couple of hours each week where the discussion is about ACA).</p>
<p>Here is the text of a UPS memo about insurance for already-insured spouses:</p>
<p><a href=“http://capsules.kaiserhealthnews.org/wp-content/uploads/2013/08/UPS-Spousal-Coverage.pdf[/url]”>http://capsules.kaiserhealthnews.org/wp-content/uploads/2013/08/UPS-Spousal-Coverage.pdf</a></p>
<p>The memo states quite clearly that the move is to save money because of rising medical costs: “We believe your spouse should be covered by their own employer-- just as UPS has the responsibility to offer coverage to you… Limiting health plan eligibility is one way to manage ongoing health care costs, now and in the future…”</p>
<p>Health care costs have been skyrocketing. This was true before the ACA, and it continues to be true (although, oddly, cost growth has slowed lately, and no one really knows why). UPS and other employers need to figure out a way to deal with those rising costs.</p>
<p>"My husband only goes there maybe 2 to 3 times a year. "</p>
<p>This is precisely what I was thinking since I have not seen a doctor in 2-3 years and wondered why I would need concierge care. I can see it makes a lot of sense when chronic illnesses requiring at least 10 visits an year being worth an extra 500-1000 to someone.</p>
<p>“Nope, not at this time. They have zip, zero, nadda enforcement authority.”</p>
<p>Aren’t people required to state whether they are insured and if not pay the fine on tax returns in future? How else can it be collected?</p>
<p>I have concierge medicine without concierge practice. My appointments with my doc are never less than 45 minutes. I usually can get in the same day, or the next day. I go when I need to. </p>
<p>Of course, my doc makes less than my wife the hospice nurse, but she’s fine with that. She makes most of her money renting out the building to other docs (but not alot.)</p>
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<p>Does not mean they are not going do it (if recent history is any indicator).</p>
<p>Here is a legal opinion that says if you are due a refund, the IRS will deduct the penalty from your refund:</p>
<p>[How</a> Health Law’s Taxes, Penalties Will Be Enforced : NPR](<a href=“How Health Law's Taxes, Penalties Will Be Enforced : NPR”>How Health Law's Taxes, Penalties Will Be Enforced : NPR)</p>
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<p>It is my understanding since the penalty is not a tax and not due to the IRS (due to an insurance company maybe) that they can not simply withhold your return. I’m not a lawyer and smarter minds than mine working the problem. </p>
<p>My info came from this particular radio show which is as reasonable a source as NPR.</p>
<p>The bottom line is the system will have a major accountability gap. It is pretty simple to make sure the IRS doesn’t owe you at the end of the year.</p>
<p>Here’s what the IRS itself has to say:</p>
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<p>[Questions</a> and Answers on the Individual Shared Responsibility Provision](<a href=“http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision]Questions”>http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision)</p>
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<p>Your understanding is incorrect. Chief Justice Roberts and the Supremes declared it a tax; otherwise, he (Roberts) would have voted against the constitutionality of the ACA.</p>
<p>^^^Thanks, I got that part backwards.</p>
<p>What is interesting in #1548 is the use of the word MAY. This is very different than MUST. Will this be on a discretionary case by case basis? When will MAY become MUST?</p>
<p>I’d say, the IRS may (= is allowed to) deduct from your refund, and for that reason, the IRS will deduct from your refund.</p>
<p>When I file taxes, I seem to invariably make some mistake with AMT or something else and have always either received an adjustment upwards or downwards to my tax in the form of a letter.</p>
<p>What stops IRS from issuing similar letters recalculating the tax burden?</p>
<p>Who actually gets the penalty $$$. Does it stay with the IRS, get rerouted to an ACA general account or simply go into one giant general fund?</p>
<p>The penalty is a tax, so I presume it must go to general tax revenues.</p>
<p>That makes it even more curious. So if one doesn’t pay the penalty one would then have an outstanding tax liability. It seems that the IRS could simply recalculate your tax due and it would then have the ability to pursue payment. Unless, of course, a tax is not a tax. </p>
<p>The annual process of filing taxes is already a little like playing dungeons and dragons. The games and strategies seem to be endless. It seems that this particular issue - IRS can bill you but not pursue payment - is one heck of a gigantic loophole that will be stretch and used to the utmost.</p>
<p>So dietz, maybe a tax is a tax when it is necessary to pass it through the Supreme Court, but we don’t want to call it a tax. Somehow “penalty” is more acceptable. It all sounds the same to me, though, whatever it is.</p>
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<p>From what I know of concierge medicine, the target market isn’t the very sick who need lots of care. It’s people who want quick, easy access, and longer individualized appointments, and can pay for it. I’ve read that concierge patients are promised, for example, that they can reach their doc personally by phone 24/7, or are guaranteed same-day appointments, or no waiting upon arrival. I know I don’t get any of that from my doctor!</p>
<p>I believe most concierge docs are primary docs, and wouldn’t be spending inordinate amounts of time on the very sick. Part of the service, though, is getting a patient hooked up with the appropriate specialist if they need it – not just a referral, but research into which specialist on the list would be the best for this patient. The doctor would have the luxury of doing what all FPs do in theory, but few have time for in practice: Keeping a watchful eye on their patient and actively managing the case, even as the patient is getting treatment from various specialists.</p>
<p>I got a curious automated phone call from my primary care physician today. He said that within a few days, all of his patients will be getting a call from a survey company about “how to better serve your healthcare needs”. This sounds to me like he may be considering a concierge practice. I hope not.</p>
<p>Sounds like it, axw. Or maybe he wants people to come in to the office more often.</p>
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<p>Nothing-- all they have to do is adjust the wording of the letter somewhat, so they don’t sound like they are threatening action (such as a levy) that they cannot take. </p>
<p>I think most people who can afford to pay their taxes will pay when they get a letter. Even though the IRS can’t levy on assets to collect that amount, they may be able to charge interest on it, so that may be part of the “threat” in the letter for unpaid amounts. I don’t know if they can also charge penalties on the penalty for nonpayment – but the point is that they can probably send a letter that says, “You owe $X and if you do not pay $X within 30 days, you will end up owing even more money, the longer you wait.”</p>
<p>So for IRS its partly an accounting problem – they will need to keep the balance of unpaid ACA tax/penalties separate from other unpaid tax obligations.</p>
<p>I think that the vast majority of people who get a letter from IRS telling them that they owe $X will pay it. Back when I practiced law, I often worked with consumers who had debt problems, and most would think that they were obligated to pay whatever a creditor was demanding. It was only when amounts were particularly odd or outrageous that resistance set in and they started to look for ways to avoid the debt.</p>
<p>Obviously there will be a small cohort of ACA tax protestors who will simply dig in their heels and refuse to pay, but I think that will be a small fraction. Most people get anxious about letters from IRS and tend to want to settle up quickly. </p>
<p>Also, while it is true that it is easy for sophisticated taxpayers to make sure that IRS doesn’t ever owe them a refund, taxpayer psychology tends to work the other way. Any financial advisor will tell people never to overpay their taxes (why let IRS earn interest off of your money?) – but taxpayers like having a refund check they can look forward, so when given the opportunity, they tend to continue to allow their withholding to exceed their tax burden.</p>