President Obama’s Affordable Care Act won’t be implemented fully until 2015. But by most every measure, and according to most every voice, things are not going well.
Health-insurance premiums are becoming more expensive, which is particularly striking when you consider that the act’s advocates promised it would decrease costs by $2,500 per person. A majority of states have chosen not to create state-based exchanges—the highly regulated ObamaCare insurance-policy marketplaces—after the Supreme Court said it would be unconstitutional for Washington to withhold certain federal funds from states to punish them if they refused to go along. The federal government must now scramble to figure out how to develop as many as 33 state-based exchanges.
The new requirement that employers provide their full-time employees with health insurance is already skewing hiring patterns and delaying efforts to get the wounded American labor force back to work. As the Los Angeles Times reported, “rather than provide health care to more workers, a growing number of employers are cutting back employee hours instead.” And a startling new study of Medicaid, on which ObamaCare relies to cover about half of the soon-to-be insured people in the country, found that Medicaid does not produce improved health outcomes for its recipients.
Meanwhile, the cost of the bill, initially estimated to be around $898 billion, has doubled, to about $1.85 trillion. A minority report from the Senate Budget Committee has the figure at $2.7 trillion. All kinds of regulatory deadlines in the bill have been missed. Confusion reigns among plans, patients, and administrators alike. Furthermore, the window that the administration has built in for running stress tests on the overall Obama-Care system is unrealistically short. All this explains why Montana Senator Max Baucus, an original sponsor of the bill and the Democratic chairman of the Senate Finance Committee, has stated that the implementation of the bill is shaping up to be a “huge train wreck.”
With all these problems, it should come as no surprise that only 35 percent of Americans have a generally favorable view of the Affordable Care Act, according to a Kaiser health poll conducted this past April. A Fox News poll also found that 54 percent would like the law repealed or reformed, roughly the same number since the law’s passage in 2010.
None of this is surprising to analysts who have been warning for years about the law’s problems. And yet, according to the leaders of the Democratic Party, the primary reason for these implementation headaches is not the law’s complexity or defiance of economic common sense. They say the fault lies with the Republican Party.
We saw this in President Obama’s performance in a late April press conference. Obama, while arguing that the law was “working fine,” also acknowledged that there would be “glitches.” And these glitches would be the fault of Republicans:
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 it 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.
The syntax may be garbled, but the gist is clear. At the same time that Obama was laying blame, he modestly added, “Having said all that, we’ve got a great team in place.” 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.”
Obama is far from the only Democrat taking this approach. Majority Leader Harry Reid also complained, on a radio show, that federal spending on implementation of ObamaCare was insufficient, again, because of the disloyal opposition. As Reid put it, “We have the menu but we don’t have any way to get to the menu.” He continued: “The president is taking money—I wish we had the money just to do it on its own, but he’s agreed, he’s determined he’s going to take money—from some of the other things that he feels are less important in the health-care bill and put it on letting you and others know what is in the bill.” The underlying message was again clear: If only Reid could get Republicans to agree to more funding for the ACA implementation, over and above the $1 billion that the federal government has already acknowledged it will spend,1 then the American people would benefit from the tasty treats offered on the ACA “menu.”
Similarly, Health and Human Services Secretary Kathleen Sebelius complained that “there was some hope that once the Supreme Court ruled…and then once an election occurred, there would be a sense that ‘this is the law of the land, let’s get on board, let’s make this work.’ And yet we will find ourselves having state-by-state political battles.” In Sebelius’s view, the fact that Republican governors did not roll over and celebrate the passage of a law they opposed makes them culpable for its failures. Democrats have their echo chamber in the media, in which similar accusations abound.
The uniformity of these accusations and the similarity of the arguments make it clear that this stratagem is not a random series of coincidental comments by prominent Democratic politicians or writers. But the timing also reveals a weakness behind the claims. For years, conservative writers have been predicting precisely what is happening now. In 2010, I wrote: “Based on what we have seen thus far, it seems that the compressed implementation window is going to lead to missed deadlines and more confusion. A poorly executed implementation could exacerbate whatever damage the bill would have caused on its own.”
In 2012, long before blame-the-GOP-game had begun, the American Action Forum released a study showing that the administration had met fewer than half of its regulatory deadlines under the Affordable Care Act. Democratic staffers have also been complaining about the administration’s failing to provide certain basics, such as a rollout plan. As one Democratic Senate staffer told Reuters: “Why in late April can’t they show us any of what they’ve got planned? The rollout plan should already be in existence.”
One can presume that the motive cause for the new emphasis on Republican obstructionism is the 2014 election. Democrats already fear that there will be a lot of negatively affected actors—payers, providers, and patients alike—who are angry about ObamaCare’s effect on them. So not only will Republicans be highlighting the many flaws of the ACA in the 2014 election; they will also be able to target specific critiques to identifiable constituencies adversely affected by the law.
There is also good reason for Democrats to be concerned from a historical perspective. When elections feature airy promises of universal health care, as they did in the 1992 or 2008 elections, Democrats can do quite well. But when elections focus on the details of Democratic proposals and the incompetence of government, as they did in 1994 or 2010, the results can be disastrous.
Democrats managed to avoid damage from the health-care issue for the most part in 2012 for two reasons. First, the Romney campaign, which had pressed repeal of ObamaCare in the primary campaign, stopped emphasizing the issue after the Supreme Court ruled in the ACA’s favor last year. Second, the as-yet unimplemented law was not then affecting everyday Americans in the way that it will be by November 2014.
With the 2014 election taking place in the first year of the ACA’s implementation, Democrats are understandably terrified that incompetent implementation could harm their prospects at the ballot box. Thus anything they can do to blame Republicans for the problems could mitigate the damage to congressional Democrats.
This may appear tactically sound, but the argument is a tough haul. In March 2010, Democrats rammed ObamaCare through the House without a single Republican vote. Republicans objected to the bill on numerous grounds, and predicted that premiums would go up, costs would not go down, and employers would lay off employees in droves. In the 2010 election, the American people sent a very clear signal that they objected to ObamaCare: Their votes flipped 63 House seats and the majority in the lower chamber to Republicans, as well as six additional Senate seats. Between 2011 and 2013, during the 112th Congress, Republicans voted to overturn the Affordable Care Act 36 times. The GOP standard-bearer in 2012 advocated the repeal of ObamaCare, and the other candidates seeking the nomination campaigned on it as well. Republicans actively and vocally backed an ultimately unsuccessful constitutional case against the ACA, which argued against the requirement that all individuals be required to purchase health care.
In short, Republicans have been eloquent and consistent opponents of the ACA throughout, and they have regularly warned that this unipartisan overhaul of our entire health-care system was unwise, inefficient, and unworkable. Voters know where Republicans stand and what they have predicted. Democrats have continued to press forward, passing the 2,700-page law without Republican support or input, writing more than 20,000 pages of regulations to implement it, and they have spent colossal sums of taxpayer dollars to put in motion (and publicize) this legislation. Now, as GOP analyses of the plan’s unworkability is starting to come true, and the implementation is proving to be just as challenging as Republicans predicted, President Obama, Senator Reid, and Secretary Sebelius have the audacity to say that the failings of their strong-arm approach are the responsibility of those who said it would never work.
The U.S. government is a large and complex body, representing a multitude of competing interests and perspectives. That is, of course, for the best when political and economic parties find solutions to the problems we face in a cooperative and bipartisan manner. But when one party unilaterally imposes its approach despite the clear opposition of the American people and the sincere and well-founded warnings of the other party, the naysayers are not obliged to cooperate in the implementation of legislation that they have explicitly and repeatedly warned will be harmful. Our system is designed to empower the people to question their leaders and for those leaders in government to take their time, listen to the people, compromise, and work together.
As the Affordable Care Act continues to come apart at nearly every seam, Republicans will probably hold firm on their principles and refuse to bail Democrats out of the fix they have put themselves into, until and unless the Democrats are willing to make real and substantive reforms. These reforms should include, at a minimum, reducing insurance subsidies, empowering Health Savings Accounts, repealing the anti-innovation medical-device tax, loosening up the rules regarding insurer participation in exchanges, and giving states more flexibility in the design of their exchanges.
Democrats have long been skillful at avoiding the blame for costly and ineffective government programs they have championed. But because of its unipartisan origins and the vocal GOP opposition every step of the way, ObamaCare is starkly different from anything we have seen before. It holds the potential to provide not only an ongoing narrative that damages the Democratic leadership, but also a real-world example of the damage that can be wrought by excessive government involvement in every aspect of American life. Someone will probably be blamed for ObamaCare if and when it fails; it won’t be those who said it would never work.
1 $1 billion has already been spent in “mandatory” funding for implementation, but overall implementation spending, which the administration has not spelled out in detail, is probably much higher.