![\"HHS](\"https:\/\/i0.wp.com\/www.dougsbriefcase.com\/blog\/wp-content\/uploads\/2013\/05\/Prototype-health-insurance-application.jpg\")
<\/a>HHS<\/span> sim\u00adpli\u00adfied the appli\u00adca\u00adtion form, but is the health law still too com\u00adpli\u00adcat\u00aded? [Cred\u00adit: TakePart.com]<\/p><\/div>\u201cThe Oba\u00admaCare Blame Game\u201d is the title of a piece by my friend and Hud\u00adson Insti\u00adtute fel\u00adlow Tevi Troy that will soon be pub\u00adlished in the June 2013 Com\u00admen\u00adtary [no link avail\u00adable]. Pars\u00ading the state\u00adments of Pres\u00adi\u00addent Oba\u00adma and oth\u00ader Demo\u00adc\u00adra\u00adt\u00adic lead\u00aders, Troy observes a curi\u00adous turn in how they talk about their new health care law: they have begun to admit that it might not work out as well as planned.\n The law\u2019s crit\u00adics have made that point for years. The law is big, cost\u00adly, com\u00adplex and high\u00adly depen\u00addent on how indi\u00advid\u00adu\u00adals, employ\u00aders and states will react to its new man\u00addates and induce\u00adments. These reac\u00adtions can be mod\u00adeled but can\u00adnot be known until the law takes effect. Healthy indi\u00advid\u00adu\u00adals may refuse to buy insur\u00adance, employ\u00aders might stop cov\u00ader\u00ading their work\u00aders, and many states already have refused to do their part in imple\u00adment\u00ading and admin\u00adis\u00adter\u00ading the law\u2019s cen\u00adtral features.<\/p>\n For more than three years, the law\u2019s back\u00aders dis\u00admissed these as the fevered fan\u00adtasies of its haters. They point\u00aded to analy\u00adses by the Con\u00adgres\u00adsion\u00adal Bud\u00adget Office and oth\u00aders sug\u00adgest\u00ading that the law would work pre\u00adcise\u00adly as designed.<\/p>\n Now they\u2019ve begun to hedge their bets. Troy cites recent com\u00adments by the Pres\u00adi\u00addent<\/a>:<\/p>\n \u201c<\/span>And when you\u2019re doing it nation\u00adwide, rel\u00ada\u00adtive\u00adly fast, and you\u2019ve got half of Con\u00adgress who is deter\u00admined to try to block imple\u00admen\u00adta\u00adtion and not ade\u00adquate\u00adly fund\u00ading imple\u00admen\u00adta\u00adtion, and then you\u2019ve got a num\u00adber of mem\u00adbers of \u2014 or gov\u00ader\u00adnors, Repub\u00adli\u00adcan gov\u00ader\u00adnors, who know that it\u2019s bad pol\u00adi\u00adtics for them to try to imple\u00adment this effec\u00adtive\u00adly and some even who have decid\u00aded to imple\u00adment and then their Repub\u00adli\u00adcan- con\u00adtrolled state leg\u00adis\u00adla\u00adtures say don\u2019t imple\u00adment and won\u2019t pass enabling leg\u00adis\u00adla\u00adtion, when you have that kind of sit\u00adu\u00ada\u00adtion, that makes it harder.<\/p>\n \u201c<\/span>But hav\u00ading said all that, we\u2019ve got a great team in place. We are push\u00ading very hard to make sure that we\u2019re hit\u00adting all the \u2014 the dead\u00adlines and the benchmarks.\u201d<\/p>\n Troy nice\u00adly sums up the President\u2019s point:<\/p>\n \u201c<\/span>The log\u00adic is unavoid\u00adable: should Oba\u00admaCare fail, then the fail\u00adure will be the respon\u00adsi\u00adbil\u00adi\u00adty of that \u2018half of Con\u00adgress\u2019 that is \u2018not ade\u00adquate\u00adly fund\u00ading imple\u00admen\u00adta\u00adtion.\u2019 But should it suc\u00adceed, then all cred\u00adit will be due to Oba\u00adma and his \u2018great team.\u2019\u201d<\/p>\n The sur\u00adpris\u00ading aspect of the President\u2019s com\u00adments is not that he blames oth\u00aders for prob\u00adlems with a law that his own par\u00adty wrote and that he signed. That is a core fea\u00adture of his lead\u00ader\u00adship style, the leit\u00admo\u00adtif of his Pres\u00adi\u00adden\u00adcy. Prob\u00adlems are invari\u00adably some\u00adone else\u2019s fault and he can\u2019t be expect\u00aded to clean up a mess he didn\u2019t make. The sur\u00adprise is that, on the eve of imple\u00adment\u00ading the sig\u00adna\u00adture leg\u00adis\u00adla\u00adtion of his Pres\u00adi\u00adden\u00adcy, he acknowl\u00adedges that it just might not work out so well after all.<\/p>\n As Troy notes, the health-care-law-might-fail-and-it\u2019s\u2011the-Repubicans\u2019-fault-if-it-does talk\u00ading point has been picked up by oth\u00ader promi\u00adnent Demo\u00adc\u00adra\u00adt\u00adic lead\u00aders, includ\u00ading HHS<\/span> Sec\u00adre\u00adtary Kath\u00adleen Sebe\u00adlius <\/a>and Sen\u00adate Major\u00adi\u00adty Leader Har\u00adry Reid <\/a>(D\u2011NV<\/span>). The prospect that the law will pro\u00adduce bad news for Democ\u00adrats in the run-up to next year\u2019s mid-term elec\u00adtion has moved from Repub\u00adli\u00adcan fan\u00adta\u00adsy to Demo\u00adc\u00adra\u00adt\u00adic fear. And Democ\u00adrats are respond\u00ading to that fear by blam\u00ading Republicans.<\/p>\n The New York Times<\/a> recent\u00adly entered the fray by spon\u00adsor\u00ading an online \u201cRoom for Debate\u201d enti\u00adtled, \u201cIs Oba\u00admaCare Too Com\u00adpli\u00adcat\u00aded to Suc\u00adceed?\u201d The Times\u2019 defen\u00adsive\u00adness on this point was reflect\u00aded in the fact that only one of the nine debaters \u2013 Michael Can\u00adnon of the Cato Insti\u00adtute \u2013 oppos\u00ades the law.<\/p>\n Dean Bak\u00ader of the Cen\u00adter for Eco\u00adnom\u00adic and Pol\u00adi\u00adcy Research offered up points that large\u00adly were repeat\u00aded by the law\u2019s 7 oth\u00ader online sup\u00adport\u00aders. In a piece enti\u00adtled, \u201c<\/span>The Only Real Prob\u00adlem is Polit\u00adi\u00adcal,\u201d <\/a>Bak\u00ader observed that the cur\u00adrent sys\u00adtem is com\u00adpli\u00adcat\u00aded (irrel\u00ade\u00advant), that the law is com\u00adpli\u00adcat\u00aded because Democ\u00adrats pan\u00addered to spe\u00adcial inter\u00adests (also irrel\u00ade\u00advant), and that Con\u00adgress should have enact\u00aded a sin\u00adgle-pay\u00ader sys\u00adtem (again irrel\u00ade\u00advant). He did allow that \u201cthere will undoubt\u00aded\u00adly be many glitch\u00ades,\u201d but took up the President\u2019s line that the real prob\u00adlem with the law\u2019s imple\u00admen\u00adta\u00adtion was not its com\u00adplex\u00adi\u00adty but its critics.<\/p>\n Oth\u00ader debaters also argued that the law will ulti\u00admate\u00adly work out just fine and that it would work even bet\u00adter if Repub\u00adli\u00adcans would just shut up. Only the Cato Institute\u2019s Can\u00adnon sug\u00adgest\u00aded that the law might fail \u2013 due not only to its com\u00adplex\u00adi\u00adty but, more impor\u00adtant\u00adly, to its unpop\u00adu\u00adlar\u00adi\u00adty. \u201cOba\u00admacare may be the law of the land,\u201d Can\u00adnon con\u00adcludes<\/a>,<\/span>\u201d but it lacks legit\u00adi\u00adma\u00adcy. So does its implementation.\u201d<\/p>\n The notion that the law lacks legit\u00adi\u00adma\u00adcy is embed\u00added in the con\u00adser\u00adv\u00ada\u00adtive psy\u00adche. Con\u00adser\u00adv\u00ada\u00adtives have crit\u00adi\u00adcized the exclu\u00adsion of Repub\u00adli\u00adcans from the process of writ\u00ading the bill, the deals the White House cut with many in the health care indus\u00adtry, and the sweet\u00aden\u00aders insert\u00aded into the bill to pro\u00adcure 60 Sen\u00adate votes (spe\u00adcial pro\u00advi\u00adsions added to win the votes of waver\u00ading law\u00admak\u00aders, with names like \u201cLouisiana Pur\u00adchase,\u201d \u201cCorn\u00adhusker Kick\u00adback\u201d and \u201cGatorAid\u201d). They have chal\u00adlenged the law\u2019s con\u00adsti\u00adtu\u00adtion\u00adal\u00adi\u00adty and encour\u00adaged states to resist its imple\u00admen\u00adta\u00adtion. They have even rebuffed efforts by the law\u2019s crit\u00adics to strike spe\u00adcif\u00adic pro\u00advi\u00adsions like the indi\u00advid\u00adual man\u00addate for fear that chang\u00ading the law might make it less objec\u00adtion\u00adable and some\u00adhow more legitimate.<\/p>\n Like the Admin\u00adis\u00adtra\u00adtion and Con\u00adgres\u00adsion\u00adal Democ\u00adrats, they have insist\u00aded that Oba\u00admacare be imple\u00adment\u00aded in its unadul\u00adter\u00adat\u00aded form, con\u00adfi\u00addent that a law that is not legit\u00adi\u00admate can\u00adnot stand.<\/p>\n This con\u00adfi\u00addence remains unshak\u00aden, despite repeat\u00aded dis\u00adap\u00adpoint\u00adments over the past 3\u20131\/2 years. At first, con\u00adser\u00adv\u00ada\u00adtives believed that the elec\u00adtion of Scott Brown in Jan\u00adu\u00adary 2010 would block the law\u2019s enact\u00adment. Then they believed that the Novem\u00adber 2010 elec\u00adtions would pro\u00adduce repeal (37 repeal votes <\/a>lat\u00ader, that remains high\u00adly unlike\u00adly). They then placed their faith in the Supreme Court, believ\u00ading it would scut\u00adtle the law. Next, they (reluc\u00adtant\u00adly) pinned their hopes on the elec\u00adtion of Mitt Rom\u00adney, who cham\u00adpi\u00adoned the law\u2019s pro\u00adto\u00adtype as Gov\u00ader\u00adnor of Mass\u00ada\u00adchu\u00adsetts but nev\u00ader\u00adthe\u00adless vowed to \u201crepeal Oba\u00admaCare on day one<\/a>.\u201d Then they thought that the states would refuse to expand Med\u00adic\u00adaid and estab\u00adlish exchanges; some have, but the fed\u00ader\u00adal gov\u00adern\u00adment is set\u00adting up exchanges in those states and even many con\u00adser\u00adv\u00ada\u00adtive Gov\u00ader\u00adnors have embraced the Med\u00adic\u00adaid expan\u00adsion. State resis\u00adtance has not, in any event, blocked the law\u2019s implementation.<\/p>\n Now the arc of con\u00adser\u00adv\u00ada\u00adtive wish\u00adful think\u00ading reach\u00ades its end\u00adpoint. Hav\u00ading failed to derail the law at the bal\u00adlot box, in Con\u00adgress, in the courts and in the states, this hope only remains: that the law, once imple\u00adment\u00aded, will fall of its own weight.<\/p>\n This hope, too, will prove illu\u00adso\u00adry. The law, in my view, has a thou\u00adsand flaws. It is too cost\u00adly, too com\u00adplex and gives the gov\u00adern\u00adment too much pow\u00ader. Imple\u00admen\u00adta\u00adtion will make those flaws appar\u00adent, but won\u2019t lead to its repeal. For one thing, a sub\u00adstan\u00adtial pro\u00adpor\u00adtion of vot\u00aders will believe, con\u00adsis\u00adtent with the line that the Pres\u00adi\u00addent and his acolytes already are ped\u00addling, that its unpleas\u00adant con\u00adse\u00adquences are the fault of Repub\u00adli\u00adcans. Just as many vot\u00aders who were unhap\u00adpy with the econ\u00ado\u00admy vot\u00aded to re-elect Pres\u00adi\u00addent Oba\u00adma because they blamed his pre\u00adde\u00adces\u00adsor for eco\u00adnom\u00adic stag\u00adna\u00adtion and job\u00adless\u00adness, mil\u00adlions will blame the Tea Par\u00adty for the program\u2019s rocky start.<\/p>\n Then there are the count\u00adless tens (hun\u00addreds?) of mil\u00adlions that health insur\u00aders, cor\u00adpo\u00adra\u00adtions, hos\u00adpi\u00adtals, drug and device\u00admak\u00aders, small busi\u00adness\u00ades and oth\u00aders have spent in prepar\u00ading to com\u00adply with the law\u2019s innu\u00admer\u00adable require\u00adments. Many were skep\u00adti\u00adcal when the law was enact\u00aded in March 2010 that it would hold up with\u00adout sub\u00adstan\u00adtial change and many dis\u00adlike it still, but as they watched Con\u00adgres\u00adsion\u00adal Repub\u00adli\u00adcans take large\u00adly sym\u00adbol\u00adic repeal votes, they rec\u00adog\u00adnized that the law would be imple\u00adment\u00aded large\u00adly as writ\u00adten, leav\u00ading them no choice but to incur the com\u00adpli\u00adance costs. Undo\u00ading the law now would mean all that mon\u00adey was wast\u00aded. And busi\u00adness\u00ades hate to waste money.<\/p>\n Most impor\u00adtant\u00adly, the law will ben\u00ade\u00adfit some peo\u00adple. Can\u00adcer sur\u00advivors who couldn\u2019t get insur\u00adance will find cov\u00ader\u00adage. The chron\u00adi\u00adcal\u00adly unem\u00adployed \u2013 and there are lots of them \u2014 will find gov\u00adern\u00adment-sub\u00adsi\u00addized health insur\u00adance more afford\u00adable. You can\u2019t spend $1.8 tril\u00adlion<\/a> with\u00adout help\u00ading some\u00adbody. And those sto\u00adries, along\u00adside tales of the law\u2019s fail\u00adings, will rever\u00adber\u00adate through\u00adout the main\u00adstream and social media. \u201cIt\u2019s a stu\u00adpid law,\u201d peo\u00adple will say, \u201cbut at least Uncle Joe got health insurance.\u201d<\/p>\n It is, of course, pos\u00adsi\u00adble that the present scan\u00addals or some unfore\u00adseen event will weak\u00aden the President\u2019s pop\u00adu\u00adlar\u00adi\u00adty to the point that prob\u00adlems with the health law\u2019s imple\u00admen\u00adta\u00adtion will become his Hur\u00adri\u00adcane Kat\u00adri\u00adna. Loss of pub\u00adlic faith in his com\u00adpe\u00adtence could cause a loss of sup\u00adport with\u00adin his own par\u00adty, forc\u00ading him to agree to a sub\u00adstan\u00adtial rewrite of the law. But that pos\u00adsi\u00adbil\u00adi\u00adty strikes me as remote.<\/p>\n In the mean\u00adtime, the Admin\u00adis\u00adtra\u00adtion will sol\u00addier on with imple\u00admen\u00adta\u00adtion efforts and the Pres\u00adi\u00addent will seek to hang the blame for the law\u2019s fail\u00adings on his polit\u00adi\u00adcal opponents.<\/p>\n","protected":false},"excerpt":{"rendered":" Oba\u00admaCare has sur\u00advived lots of near-death expe\u00adri\u00adences over the past 3\u20131\/2 years: the elec\u00adtion of Scott Brown, a Supreme Court chal\u00adlenge, the pres\u00adi\u00adden\u00adtial elec\u00adtions, and refusal by a num\u00adber of Gov\u00ader\u00adnors to help in its imple\u00admen\u00adta\u00adtion. With the new health insur\u00adance exchanges just 4 months from open\u00ading and the full launch of the pro\u00adgram set for Jan\u00adu\u00adary 1, many con\u00adser\u00adv\u00ada\u00adtives believe that the pro\u00adgram will fall of its own weight. Wish\u00adful think\u00ading? Con\u00adtin\u00adue read\u00ading