![HHS simplified the application form, but is the health law still too complicated? [Credit: TakePart.com]](https://i0.wp.com/www.dougsbriefcase.com/blog/wp-content/uploads/2013/05/Prototype-health-insurance-application.jpg)
HHS simplified the application form, but is the health law still too complicated? [Credit: TakePart.com]
The law’s critics have made that point for years. The law is big, costly, complex and highly dependent on how individuals, employers and states will react to its new mandates and inducements. These reactions can be modeled but cannot be known until the law takes effect. Healthy individuals may refuse to buy insurance, employers might stop covering their workers, and many states already have refused to do their part in implementing and administering the law’s central features.
For more than three years, the law’s backers dismissed these as the fevered fantasies of its haters. They pointed to analyses by the Congressional Budget Office and others suggesting that the law would work precisely as designed.
Now they’ve begun to hedge their bets. Troy cites recent comments by the President:
“And when you’re doing it nationwide, relatively fast, and you’ve got half of Congress who is determined to try to block implementation and not adequately funding implementation, and then you’ve got a number of members of — or governors, Republican governors, who know that it’s bad politics for them to try to implement this effectively and some even who have decided to implement and then their Republican- controlled state legislatures say don’t implement and won’t pass enabling legislation, when you have that kind of situation, that makes it harder.
“But having said all that, we’ve got a great team in place. We are pushing very hard to make sure that we’re hitting all the — the deadlines and the benchmarks.”
Troy nicely sums up the President’s point:
“The logic is unavoidable: should ObamaCare fail, then the failure will be the responsibility of that ‘half of Congress’ that is ‘not adequately funding implementation.’ But should it succeed, then all credit will be due to Obama and his ‘great team.’”
The surprising aspect of the President’s comments is not that he blames others for problems with a law that his own party wrote and that he signed. That is a core feature of his leadership style, the leitmotif of his Presidency. Problems are invariably someone else’s fault and he can’t be expected to clean up a mess he didn’t make. The surprise is that, on the eve of implementing the signature legislation of his Presidency, he acknowledges that it just might not work out so well after all.
As Troy notes, the health-care-law-might-fail-and-it’s‑the-Repubicans’-fault-if-it-does talking point has been picked up by other prominent Democratic leaders, including HHS Secretary Kathleen Sebelius and Senate Majority Leader Harry Reid (D‑NV). The prospect that the law will produce bad news for Democrats in the run-up to next year’s mid-term election has moved from Republican fantasy to Democratic fear. And Democrats are responding to that fear by blaming Republicans.
The New York Times recently entered the fray by sponsoring an online “Room for Debate” entitled, “Is ObamaCare Too Complicated to Succeed?” The Times’ defensiveness on this point was reflected in the fact that only one of the nine debaters – Michael Cannon of the Cato Institute – opposes the law.
Dean Baker of the Center for Economic and Policy Research offered up points that largely were repeated by the law’s 7 other online supporters. In a piece entitled, “The Only Real Problem is Political,” Baker observed that the current system is complicated (irrelevant), that the law is complicated because Democrats pandered to special interests (also irrelevant), and that Congress should have enacted a single-payer system (again irrelevant). He did allow that “there will undoubtedly be many glitches,” but took up the President’s line that the real problem with the law’s implementation was not its complexity but its critics.
Other debaters also argued that the law will ultimately work out just fine and that it would work even better if Republicans would just shut up. Only the Cato Institute’s Cannon suggested that the law might fail – due not only to its complexity but, more importantly, to its unpopularity. “Obamacare may be the law of the land,” Cannon concludes,” but it lacks legitimacy. So does its implementation.”
The notion that the law lacks legitimacy is embedded in the conservative psyche. Conservatives have criticized the exclusion of Republicans from the process of writing the bill, the deals the White House cut with many in the health care industry, and the sweeteners inserted into the bill to procure 60 Senate votes (special provisions added to win the votes of wavering lawmakers, with names like “Louisiana Purchase,” “Cornhusker Kickback” and “GatorAid”). They have challenged the law’s constitutionality and encouraged states to resist its implementation. They have even rebuffed efforts by the law’s critics to strike specific provisions like the individual mandate for fear that changing the law might make it less objectionable and somehow more legitimate.
Like the Administration and Congressional Democrats, they have insisted that Obamacare be implemented in its unadulterated form, confident that a law that is not legitimate cannot stand.
This confidence remains unshaken, despite repeated disappointments over the past 3–1/2 years. At first, conservatives believed that the election of Scott Brown in January 2010 would block the law’s enactment. Then they believed that the November 2010 elections would produce repeal (37 repeal votes later, that remains highly unlikely). They then placed their faith in the Supreme Court, believing it would scuttle the law. Next, they (reluctantly) pinned their hopes on the election of Mitt Romney, who championed the law’s prototype as Governor of Massachusetts but nevertheless vowed to “repeal ObamaCare on day one.” Then they thought that the states would refuse to expand Medicaid and establish exchanges; some have, but the federal government is setting up exchanges in those states and even many conservative Governors have embraced the Medicaid expansion. State resistance has not, in any event, blocked the law’s implementation.
Now the arc of conservative wishful thinking reaches its endpoint. Having failed to derail the law at the ballot box, in Congress, in the courts and in the states, this hope only remains: that the law, once implemented, will fall of its own weight.
This hope, too, will prove illusory. The law, in my view, has a thousand flaws. It is too costly, too complex and gives the government too much power. Implementation will make those flaws apparent, but won’t lead to its repeal. For one thing, a substantial proportion of voters will believe, consistent with the line that the President and his acolytes already are peddling, that its unpleasant consequences are the fault of Republicans. Just as many voters who were unhappy with the economy voted to re-elect President Obama because they blamed his predecessor for economic stagnation and joblessness, millions will blame the Tea Party for the program’s rocky start.
Then there are the countless tens (hundreds?) of millions that health insurers, corporations, hospitals, drug and devicemakers, small businesses and others have spent in preparing to comply with the law’s innumerable requirements. Many were skeptical when the law was enacted in March 2010 that it would hold up without substantial change and many dislike it still, but as they watched Congressional Republicans take largely symbolic repeal votes, they recognized that the law would be implemented largely as written, leaving them no choice but to incur the compliance costs. Undoing the law now would mean all that money was wasted. And businesses hate to waste money.
Most importantly, the law will benefit some people. Cancer survivors who couldn’t get insurance will find coverage. The chronically unemployed – and there are lots of them — will find government-subsidized health insurance more affordable. You can’t spend $1.8 trillion without helping somebody. And those stories, alongside tales of the law’s failings, will reverberate throughout the mainstream and social media. “It’s a stupid law,” people will say, “but at least Uncle Joe got health insurance.”
It is, of course, possible that the present scandals or some unforeseen event will weaken the President’s popularity to the point that problems with the health law’s implementation will become his Hurricane Katrina. Loss of public faith in his competence could cause a loss of support within his own party, forcing him to agree to a substantial rewrite of the law. But that possibility strikes me as remote.
In the meantime, the Administration will soldier on with implementation efforts and the President will seek to hang the blame for the law’s failings on his political opponents.
Excellent article. As usual you have the politics and the issues summed up nicely. Always enjoy reading your updates.
Thanks, Joe. I have fun writing these. Glad you’re reading. Your Sawx are hot!
Doug