The Affordable Care Act (also known as Obamacare or the ACA) has been at the center of a political firestorm since its inception in 2010. Now that several more major pieces of its legislation are set to come into effect as of January 1, 2014, the controversy over this landmark healthcare reform legislation has only intensified. New policies include the Affordable Care Act’s mandate that all small business owners with more than 50 full-time employees must provide health insurance benefits to their full-time staff. Several large US employers have made public statements regarding opting out of Obamacare. Employers can choose to pay a financial penalty to escape the policy, but some employers have gone a step further by shifting large portions of company workforces to part-time labor. This allows companies to circumvent current Affordable Care Act stipulations for full-time employees, which would raise health insurance costs for many small business owners.
In response, the Affordable Care Act legislation established the Small Business Health Options Program (SHOP) to help small business owners manage the transition to providing an insured workplace for their employees. Small business owners can also use SHOP to directly compare public health insurance coverage plans that are available in their region. Opponents of the Affordable Care Act have claimed that these new policies will push a massive wave of small business owners (who typically operate with smaller loan credit and profit margin than larger corporations) toward re-structuring their workforces in favor of part-time labor. This shift, opponents claim, would defeat the original purpose of the ACA: to expand access to health insurance and healthcare services for US citizens. With lower wages and reduced access to health insurance, families would then be forced to find less viable alternatives to traditional healthcare providers.
These alternative routes include cash-only healthcare clinics. While not, strictly speaking, functioning as a black market (cash-only clinics are still frequently staffed by medical professionals) the repayment infrastructure is such that some cash-only clinics refuse to deal with health insurance companies entirely. This means that if families wish to seek care (typically outpatient or ambulatory procedures, as cash-only clinics are often less widely-equipped than municipal hospitals), they must finance 100% of the costs out-of-pocket. This eliminates administrative fees paid to health insurance companies, but without health insurance, the benefits to families who operate with little disposable income are marginal at best. Many families may incur extreme medical debt to obtain necessary care at such cash-only clinics. The long-term effects of the ACA on the operations in such industry remain to be seen.