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The Stakeholders: The Florida doctor suing over the employer mandate

Dr. Larry Kawa is a Florida orthodontist who filed a lawsuit charging that Obama's executive order delaying the employee mandate of the ACA broke the law.
Dr. Larry Kawa, center, speaks about his lawsuit against the IRS regarding the employer mandate in the Affordable Care Act.
Dr. Larry Kawa, center, speaks about his lawsuit against the IRS regarding the employer mandate in the Affordable Care Act.

The stakeholders in the Obamacare rollout aren’t just in Washington, D.C. Across the United States, health care providers, small-business owners, patients, and others are all affected by the law. In a new msnbc series, we send an Obamacare questionnaire to people all over the country – places where health care exchanges have been set up, those where they have not been set up, and those where the debate continues. Through it all we hope to understand one thing: How Obamacare is affecting the lives of Americans.

Dr. Larry Kawa, 48, is a Florida orthodontist who, along with the conservative legal organization Judicial Watch, filed a lawsuit against the IRS in 2013, charging that the Obama administration's executive order delaying the employee mandate until 2015 breaks the law and is an abuse of executive power. Kawa, who is considered a "large employer" under the ACA because he employs more than 50 people at his Boca Raton practice, alleges that he spent money and time to make sure his business would be in compliance ahead of the Dec. 31, 2013 deadline. He is suing for the mandate to go into effect immediately. 

The suit was dismissed without prejudice in the U.S. District Court for the Southern District of Florida in January where a judge said Kawa Orthodontics did not have legal standing to sue, but Kawa filed an appeal in the 11th Circuit Court of Appeals in Atlanta.

Q: What were the biggest problems with our health care system before the ACA?

Larry Kawa: The biggest problems with our health care system for most people before the ACA were rising out of pocket costs, finding a doctor in your network, and getting experimental procedures covered for major disease care. While the cost of individual plans may have been high, group plans offered by employers were very manageable and affordable for everyone involved. Most all employers who had 50 full-time employees or more did offer some form of health insurance. While many individuals were uncovered, a great number tended to be people who did not actively seek health care insurance, such as young people who have statistically lower rates of infections and hospitalizations. 

Q: In your experience, is the health care law adequately addressing those problems?

LK: Since the enactment of the ACA, the Medicare Advisory Board, and hence insurance companies, have taken significant steps to limit the reimbursement to primary care physicians and specialists. As you would imagine, if you increase the amount of patients to be seen and freeze the reimbursement rate for the next 10 years, physicians will be left carrying the financial burden for treating these patients. Subsequently, I’ve seen physicians and other medical professionals, either start to move towards leaving the major insurance networks by not taking insurance at all (and having everyone pay privately), or making individuals pay in full upfront and then having them seek reimbursement from their insurance company, which is usually only a partial reimbursement if any. 

With the implementation of the ACO (Accountable Care Organizations that provide coordinated care for Medicaid patients), it will be interesting to see how individuals in those plans fare when their treatment gets expensive. If the government only gives a physician a certain amount of budget to treat a patient population and one patient starts getting too expensive, most likely that person won’t receive all of the medical care that they need. While there are principles in the ACO that I like, having the government give your doctor a financial incentive not to treat you is not one of them.

In regards to employer coverage, the cost of employer based health care coverage has gone up, including my company’s health care premiums. The estimates for next year look even worse. In these economic times, we don’t want to be increasing the financial burden on responsible employers who want to take care of their employees. While this was not the case in my practice, there are businesses who had their employee policies cancelled because the polices didn’t meet the ACA requirements. While some corrective measures were taken to fix this, the damage had already been done. 

As far as insuring the uninsured, a recent McKinsey analysis showed that only 17% of the signups where previously uninsured. Basically, we are insuring people for the most part who already had health insurance but whom had their policies cancelled because of the new ACA law. Young people have also not enrolled as planned in the health care system under the ACA, which has had an adverse effect on premiums. 

Q: In what ways has Obamacare affected you?

LK: The biggest way Obamacare has affected me personally is through my business. While I may not believe in the law’s effectiveness, I do respect my country and its laws, so I wanted to follow it in good faith. After expending a great number of hours on Obamacare limiting my ability to generate new business, and thousands in legal fees to make sure that my business was in compliance, I was told via a blog post from the administration that all of my time, money, and effort to comply with the law for 2014 was wasted. Since then, the healthcare law has been changed without approval from Congress many times, but the changing of the employer mandate requirement has most damaged my business. 

Since the President doesn’t seem to be wiling to give employers stability in the law, I have taken my dispute with the administration to federal court. My case(Kawa Orthodontics, LLP vs. Jack Lew, et al(No. 9:13-cv-80990))  is the most serious legal challenge to the non-Congressionally approved waiver of the employer mandate. As a tax paying and law abiding citizen, I just want to see the laws enforced, including the employer mandate. After its implementation, then people can judge the quality and efficacy of this law.

My business and employees have also seen increases in their health care premiums, which has adversely affected them. 

Q: What is the one thing that people should understand about the ACA based on your experience?

LK: We’ve heard from Senator Harry Reid that all of the Obamacare horror stories are false. I’m here to say that my Obamacare horror story is true. Obamacare has affected real people with real businesses, who have to take care of real families. 

There is a propensity to think that Obamacare is only hurting large multinational conglomerates that can afford to take whatever financial penalties the government wants to inflict on them. I am a local orthodontist with one office in South Florida. In total, my business has suffered over $1 million in total damages as a result of Obamacare and the implementation of the employer mandate. 

I’m not here to say that everything about the law is bad, but the reality is this law is far from perfect. Instead of defending the law for fear that it might be taken away, our elected leaders should take off the blinders that come with living in Washington D.C. and see what’s really going on in America. 

I’m sure they’ll find some good and some bad, but to think that everything bad about Obamacare is a lie, is irresponsible at best. As long as Americans open their eyes to this health care law and judge it by the merit of its implementation and performance, we can come up with real ways to fix the problems of health care, instead of blindly defending our political parties.   

Q: What are your most concerned or excited about haead of the March 31st deadline?

LK: I hope that as many people who need health insurance enroll before the end of open enrollment. I am concerned that young people will not sign up as expected ruining the financial projections that Obamacare was built on, and subsequently raising the costs and premiums for those that are in the health care system.