{"id":446,"date":"2013-04-25T10:21:14","date_gmt":"2013-04-25T14:21:14","guid":{"rendered":"http:\/\/www.dougsbriefcase.com\/blog\/?p=446"},"modified":"2013-04-26T14:48:17","modified_gmt":"2013-04-26T18:48:17","slug":"the-tortured-politics-of-the-health-care-law","status":"publish","type":"post","link":"https:\/\/www.dougsbriefcase.com\/blog\/the-tortured-politics-of-the-health-care-law\/","title":{"rendered":"The Tortured Politics of the Health Care Law"},"content":{"rendered":"
\"Boehner

Putting aside per\u00adson\u00adal ani\u00admos\u00adi\u00adty for the greater good.<\/p><\/div>\n

House con\u00adser\u00adv\u00ada\u00adtives yes\u00adter\u00adday scut\u00adtled a bill that would have denied the White House mon\u00adey it urgent\u00adly needs to imple\u00adment the new health reform law. But a promi\u00adnent Sen\u00adate Demo\u00adc\u00adrat, who helped write the law, maneu\u00advered to deny the Admin\u00adis\u00adtra\u00adtion those des\u00adper\u00adate\u00adly need\u00aded funds. Mean\u00adwhile, Speak\u00ader Boehn\u00ader and Sen\u00adate Demo\u00adc\u00adra\u00adt\u00adic Major\u00adi\u00adty Leader Har\u00adry Reid are locked in qui\u00adet talks to exempt them\u00adselves and their staffs from the new law.<\/p>\n

Got all that?<\/p>\n

Let\u2019s start with the House Repub\u00adli\u00adcans because they\u2019re almost always the most inter\u00adest\u00ading group. They are the new health law\u2019s most stri\u00addent oppo\u00adnents and also its most impor\u00adtant enablers. Since the law\u2019s enact\u00adment, they have staunch\u00adly main\u00adtained that it must either be repealed entire\u00adly or imple\u00adment\u00aded pre\u00adcise\u00adly as writ\u00adten. Any change to the law, they main\u00adtain, is an unac\u00adcept\u00adable effort to \u201cimprove\u201d a bad prod\u00aduct. So they have become the Administration\u2019s most impor\u00adtant ally in mak\u00ading sure that the law they despise is imple\u00adment\u00aded on time and with as few hitch\u00ades as possible.<\/p>\n

Con\u00adfused?<\/p>\n

Let me cite the most recent exam\u00adple. Mil\u00adlions of Amer\u00adi\u00adcans will start sign\u00ading up for health insur\u00adance cov\u00ader\u00adage under the new law on Octo\u00adber 1. They will do this through exchanges<\/a>,<\/span> com\u00adpli\u00adcat\u00aded admin\u00adis\u00adtra\u00adtive mech\u00ada\u00adnisms that will enroll peo\u00adple in cov\u00ader\u00adage, deter\u00admine if they\u2019re eli\u00adgi\u00adble for sub\u00adsi\u00addies or Med\u00adic\u00adaid, and then send those sub\u00adsi\u00addies, not to the enrollee, but to the insur\u00adance com\u00adpa\u00adny of the enrollee\u2019s choos\u00ading. The archi\u00adtects of the law thought that states would elect to oper\u00adate these exchanges. But most states have decid\u00aded that they don\u2019t want the headache and expense of cre\u00adat\u00ading a new bureau\u00adcra\u00adcy to coor\u00addi\u00adnate with the IRS<\/span>, the state Med\u00adic\u00adaid agency, fed\u00ader\u00adal and state insur\u00adance reg\u00adu\u00adla\u00adtors, and numer\u00adous insur\u00adance com\u00adpa\u00adnies, among oth\u00aders. So 27 states<\/a> have dumped this has\u00adsle onto the fed\u00ader\u00adal government<\/p>\n

This is a respon\u00adsi\u00adbil\u00adi\u00adty for which the fed\u00ader\u00adal gov\u00adern\u00adment was poor\u00adly pre\u00adpared. They lack mon\u00adey to estab\u00adlish the exchanges. So the Depart\u00adment of Health and Human Ser\u00advices came up with the idea of tak\u00ading the mon\u00adey from a hon\u00adey\u00adpot estab\u00adlished by the health care law: a fund<\/a> the depart\u00adment can use at its dis\u00adcre\u00adtion for dis\u00adease pre\u00adven\u00adtion and pub\u00adlic health. The depart\u00adment plans to take hun\u00addreds of mil\u00adlions out of this fund<\/a> and spend it on fed\u00ader\u00adal exchanges.<\/p>\n

House Repub\u00adli\u00adcan Leader Eric Can\u00adtor (R\u2011VA<\/span>) saw a polit\u00adi\u00adcal oppor\u00adtu\u00adni\u00adty. Unfor\u00adtu\u00adnate\u00adly, he for\u00adgot to check with his followers.<\/p>\n

Can\u00adtor wrote a bill<\/a> to block HHS<\/span> from tak\u00ading mon\u00adey out of the fund to pay for exchanges. With\u00adout that mon\u00adey, the law\u2019s imple\u00admen\u00adta\u00adtion would be in jeop\u00adardy. Instead, the Can\u00adtor bill would have shift\u00aded the mon\u00adey to anoth\u00ader fund that was estab\u00adlished by the health care law to help pay for insur\u00adance cov\u00ader\u00adage for peo\u00adple with pre-exist\u00ading med\u00adical con\u00addi\u00adtions.  That fund is short on cash.<\/p>\n

Cantor\u2019s bill would have pre\u00adsent\u00aded Democ\u00adrats with a very tricky polit\u00adi\u00adcal vote. The health insur\u00adance exchanges are poor\u00adly under\u00adstood bureau\u00adcrat\u00adic enti\u00adties. The pub\u00adlic health fund, because of its size and the broad author\u00adi\u00adty it gives the Sec\u00adre\u00adtary to fund projects of her pleas\u00ading, has a bit of a bad rep\u00adu\u00adta\u00adtion in many quar\u00adters. So why not take mon\u00adey from that fund and use it to help buy insur\u00adance for peo\u00adple with med\u00adical needs?<\/p>\n

Why not? Because, in the words of con\u00adser\u00adv\u00ada\u00adtive House Mem\u00adber Justin Amash<\/a> (R\u2011MI<\/span>),<\/p>\n

\u201c<\/span>We\u2019re shift\u00ading mon\u00adey from one part of Oba\u00admacare we don\u2019t sup\u00adport to anoth\u00ader part of Oba\u00admacare we don\u2019t support.\u201d<\/p><\/blockquote>\n

Let\u2019s think about that log\u00adic.  Accord\u00ading to Amash, the only way to prove that you real\u00adly hate what he calls \u201cOba\u00admacare\u201d is to oppose all efforts to change it. Amash and fel\u00adlow House con\u00adser\u00adv\u00ada\u00adtives, by their lights, must oppose their own lead\u00ader\u00adship and side with the Admin\u00adis\u00adtra\u00adtion, allow\u00ading it to raid the pre\u00adven\u00adtion fund to facil\u00adi\u00adtate imple\u00admen\u00adta\u00adtion of the law Amash hates.  And he\u2019s not alone among House Republicans.<\/p>\n

So Can\u00adtor, faced with sub\u00adstan\u00adtial oppo\u00adsi\u00adtion from his GOP<\/span> col\u00adleagues, yes\u00adter\u00adday pulled the bill from House con\u00adsid\u00ader\u00ada\u00adtion. The Admin\u00adis\u00adtra\u00adtion breathed a sigh of relief, since that removed one poten\u00adtial obsta\u00adcle from its imple\u00admen\u00adta\u00adtion plans. Prob\u00adlem solved, thanks to House Repub\u00adli\u00adcans, right?<\/p>\n

Not so fast.<\/p>\n

No soon\u00ader had Can\u00adtor sig\u00adnaled his retreat than Sen\u00adate HELP<\/span> Com\u00admit\u00adtee Chair\u00adman Tom Harkin (D\u2011IA<\/span>) stepped up to object to the Administration\u2019s plan. Tom Harkin? Isn\u2019t he a vocal sup\u00adport\u00ader of the health care law? Didn\u2019t he help write it?<\/p>\n

You bet he did. And one of the things he wrote into the bill was the pre\u00adven\u00adtion and pub\u00adlic health fund, the one that HHS<\/span> wants to tap to pay for health exchanges.<\/p>\n

So when Sen\u00adate Major\u00adi\u00adty Leader Har\u00adry Reid (D\u2011NV<\/span>) yes\u00adter\u00adday sought to engi\u00adneer unan\u00adi\u00admous approval to begin Sen\u00adate debate on Mar\u00adi\u00adlyn Tavenner\u2019s appoint\u00adment to head the agency that is imple\u00adment\u00ading the health reform law, he got an unpleas\u00adant sur\u00adprise: Harkin object\u00aded<\/a>.<\/p>\n

Seems that Chair\u00adman Harkin loves him some pre\u00adven\u00adtion and pub\u00adlic health fund. The fund lost $5 bil\u00adlion last year as part of a deal to pay for the President\u2019s pay\u00adroll tax hol\u00adi\u00adday. Harkin wasn\u2019t hap\u00adpy at the time, but thought he had a deal with the White House that they would keep their hands off his fund in the future.<\/p>\n

\u201c<\/span>You\u2019ve got to under\u00adstand that last year, Oba\u00adma took $5 bil\u00adlion out,\u201d Harkin told Politi\u00adco<\/a>.  \u201cThat\u2019s when I thought I had an agree\u00adment that they were nev\u00ader going to do this again. Now they come and actu\u00adal\u00adly \u2014 once it\u2019s all worked out it\u2019s about $332 mil\u00adlion they\u2019re tak\u00ading out of it this year.\u201d<\/p><\/blockquote>\n

 <\/p>\n

\u201c<\/span>I\u2019m sor\u00adry to say this admin\u00adis\u00adtra\u00adtion just doesn\u2019t seem to get it,\u201d he said. \u201cIt\u2019s sort of like the pre\u00adven\u00adtion fund is sort of an afterthought.\u201d<\/p><\/blockquote>\n

By tak\u00ading the Taven\u00adner nom\u00adi\u00adna\u00adtion hostage, Harkin hopes to get the White House to keep its hands off his fund. That puts the Admin\u00adis\u00adtra\u00adtion in the posi\u00adtion of hav\u00ading to choose between get\u00adting the mon\u00adey it needs for its health insur\u00adance exchanges and hav\u00ading its nom\u00adi\u00adnee to over\u00adsee the law\u2019s imple\u00admen\u00adta\u00adtion con\u00adfirmed by the Sen\u00adate. Harkin believes that he can help HHS<\/span> find the mon\u00adey else\u00adwhere. His nego\u00adti\u00ada\u00adtions with the White House are expect\u00aded to con\u00adtin\u00adue today.<\/p>\n

But that isn\u2019t the most inter\u00adest\u00ading ongo\u00ading health care nego\u00adti\u00ada\u00adtion. That would be the one involv\u00ading the Admin\u00adis\u00adtra\u00adtion, Sen\u00ada\u00adtor Reid and his bit\u00adter foe, John Boehn\u00ader. [Boehn\u00ader once told Reid to \u201cgo f___ your\u00adself<\/a>\u201d after Reid accused him of run\u00adning a \u201cdic\u00adta\u00adtor\u00adship<\/a>.\u201d]  But real lead\u00aders nev\u00ader let per\u00adson\u00adal ani\u00admos\u00adi\u00adty impair their abil\u00adi\u00adty to nego\u00adti\u00adate across the aisle in times of cri\u00adsis. And Reid and Boehn\u00ader face a real cri\u00adsis: unless some\u00adthing is done, Mem\u00adbers of Con\u00adgress and their staffs will have to sign up for health cov\u00ader\u00adage under the new exchanges.<\/p>\n

Con\u00adgres\u00adsion\u00adal employ\u00adees, includ\u00ading Mem\u00adbers of Con\u00adgress, cur\u00adrent\u00adly par\u00adtic\u00adi\u00adpate in the Fed\u00ader\u00adal Employ\u00adees Health Ben\u00ade\u00adfit Plan (FEHB<\/span>). Under that pro\u00adgram, tax\u00adpay\u00aders pick up, on aver\u00adage, 72 per\u00adcent of their pre\u00admi\u00adums. But under the new health reform law, they would be kicked out of the FEHB<\/span> and forced to buy cov\u00ader\u00adage through the health insur\u00adance exchanges. You know, like mil\u00adlions of us.<\/p>\n

But that would be, um, expensive.<\/p>\n

\u201c<\/span>Put your\u00adself in the posi\u00adtion of a lot of entry-lev\u00adel staff peo\u00adple who make $25,000 a year, and all of a sud\u00adden, they have a $7,000 a year health care tab?\u201d  Sen\u00ada\u00adtor Richard Burr <\/a>(R\u2011NC<\/span>) told Politi\u00adco.  \u201cThat would be devastating.\u201d<\/p><\/blockquote>\n

So, you see, law\u00admak\u00aders aren\u2019t wor\u00adried about them\u00adselves. They\u2019re wor\u00adried about the staffers that they pay so poor\u00adly. Well, maybe. Actu\u00adal\u00adly a staffer earn\u00ading $25,000 would receive gov\u00adern\u00adment sub\u00adsi\u00addies if they bought their cov\u00ader\u00adage through an exchange. Those sub\u00adsi\u00addies would reduce the pre\u00admi\u00adums in Sen. Burr\u2019s hypo\u00adthet\u00adi\u00adcal exam\u00adple to $1,726, accord\u00ading to the Kaiser Foundation\u2019s pre\u00admi\u00adum cal\u00adcu\u00adla\u00adtor<\/a>. That\u2019s actu\u00adal\u00adly less than the $1,960 they would pay now for cov\u00ader\u00adage under the FEHB<\/span>, assum\u00ading the gov\u00adern\u00adment pays 72 per\u00adcent of the $7000 premium.<\/p>\n

OK<\/span>, so maybe the law\u00admak\u00aders are per\u00adhaps a bit wor\u00adried about them\u00adselves, since they earn too much to receive subsidies.<\/p>\n

One dif\u00adfer\u00adence between them and the rest of us is that they have the pow\u00ader to exempt them\u00adselves from the law\u2019s appli\u00adca\u00adtion. The oth\u00ader dif\u00adfer\u00adence is that they have to answer to vot\u00aders. And that is com\u00adpli\u00adcat\u00ading the nego\u00adti\u00ada\u00adtions over exempt\u00ading them\u00adselves from the law. There are only two ways that this could work polit\u00adi\u00adcal\u00adly: the Admin\u00adis\u00adtra\u00adtion could give Mem\u00adbers and their staffs a waiv\u00ader or Con\u00adgress could over\u00adwhelm\u00ading\u00adly pass a law grant\u00adi\u00adng them\u00adselves such a waiver.<\/p>\n

\u201c<\/span>Every\u00adone has to hold hands on this and jump, or noth\u00ading is going to get done,\u201d  a source close to the nego\u00adti\u00ada\u00adtions <\/a>told Politi\u00adco.<\/p><\/blockquote>\n

So there you have it: a coau\u00adthor of the health reform law is threat\u00aden\u00ading its imple\u00admen\u00adta\u00adtion after House Repub\u00adli\u00adcans snub a bill that would have done just that, while lead\u00aders of both par\u00adties qui\u00adet\u00adly try to get them\u00adselves out from under the law.<\/p>\n

Just anoth\u00ader day in health policy.<\/p>\n","protected":false},"excerpt":{"rendered":"

Bizarro World Update: One of the Health Care law\u2019s authors is now try\u00ading to block the Admin\u00adis\u00adtra\u00adtion\u2019s plan to fund the law\u2019s imple\u00admen\u00adta\u00adtion while Leader Reid and Speak\u00ader Boehn\u00ader are look\u00ading for a way to exempt them\u00adselves from the new law. Con\u00adfused? Con\u00adtin\u00adue read\u00ading \u2192<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":447,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","wp_typography_post_enhancements_disabled":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"nfd_image_url":"","nfd_onboarding_generated":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[17,16,19],"tags":[120,121,129,130,117,119,122,118,54,116,123,132,126,1184,1188,127,128,131,125],"class_list":["post-446","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-entitlements","category-health-care","category-politics","tag-department-of-health-and-human-services","tag-eric-cantor","tag-federal-employees-health-benefit-plan","tag-fehb","tag-harry-reid","tag-health-insurance","tag-hhs","tag-house-republicans","tag-irs","tag-john-boehner","tag-justin-amash","tag-kaiser-foundation","tag-marilyn-tavenner","tag-medicaid","tag-obamacare","tag-politico","tag-prevention-and-public-health-fund","tag-senator-richard-burr","tag-tom-harkin"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t