Last week, the White House issued a new “study” on the supposed progress states have made in implementing the “health exchanges” that are central to constructing the Obamacare system. According to the administration’s spin, some 28 states are “on their way” toward establishing the exchanges, so everything is apparently well under control. In other words, nothing to worry about here. Full speed ahead!
But is that really what’s going on here?
Because, even if one were to accept the White House’s accounting (which one shouldn’t), that would mean that 22 states — roughly 40 percent of the country — are not “on their way” toward erecting the Obamacare exchanges. Isn’t that a problem? Further, upon closer inspection, it’s clear that many of the 28 states that are supposedly “on their way” really aren’t “on their way.” That’s just comical White House spin, in which the truly inconsequential — the acceptance of minor federal grant money, or the setting up of a committee to “study” the question — is elevated into a sure sign that Obamacare is a fait accompli. It’s ridiculous.
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A more accurate description of what is going on would go like this: The bluest of blue states (and the District of Columbia) are, not surprisingly, moving ahead with Obamacare implementation, and are at various stages in the process. That list includes California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New York, Oregon, Rhode Island, Vermont, and Washington. In addition, three states — Colorado, Nevada, and West Virginia — that tend to be more competitive politically (that is, they aren’t simply red or blue states) are nonetheless moving ahead with some form of exchange that, at the moment at least, looks to be roughly consistent with what the administration has in mind. So the administration can rightly claim 15 states are more or less playing ball with them.
But with the other 35 states, the picture is very, very different.
For starters, there’s a very long list of states — nearly 30 — with strong Republican governors who have absolutely no interest in doing anything to solidify the position of Obamacare as the inevitable blueprint for our future. Think Texas, and Florida, and Indiana, and Iowa, and New Mexico, and Kansas. The leaders of these states understand that, White House spin notwithstanding, Obamacare is far from being settled policy. The Supreme Court will be issuing its ruling on the law this spring or summer, and the voters will get another say on the entire matter this November when they cast their ballots in the presidential race and House and Senate contests. With so much uncertainty surrounding the law, Republican governors have every reason to sit back and wait to see what happens this year before any decisions are made. And that’s exactly what the vast majority of them are doing.
In other states, with mixed political control, it’s not entirely clear what direction they will go, as the legislatures and the governors are either at odds over the issue or have deferred taking any definitive steps. By no means can these states be considered “on their way” toward Obamacare implementation.
So, a fair reading of what’s really going on is that the vast majority of states are not proceeding apace to implement Obamacare, and there’s no prospect of their doing so anytime soon.
Even so, according to the White House, that also isn’t something to worry about. Because, according to White House Deputy Chief of Staff Nancy-Ann DeParle, if the states aren’t ready to go with the exchanges in early 2013, then the federal government will step in and run the whole program itself.
Really?
Because, if the federal government is going to do this, it would need the capacity to run successfully what will be one of the nation’s largest welfare programs, doing real-time income verification on tens of millions of people who may or may not qualify for the law’s massive entitlement expansions. There’s no precedent for this kind of undertaking, and a recent news story made it abundantly clear that the experts in the field seriously doubt the federal government can do this by 2014. Indeed, it’s becoming clearer by the day that not only is Obamacare disastrous for the federal budget and the health-care system, it is also fast becoming an implementation train wreck.
Obamacare is under siege at this point. It is on shaky ground legally. It’s opposed by a plurality of voters. And there’s no real plan in view for actually implementing it, even if it were to survive the various challenges coming its way. No wonder the White House is resorting to unsubstantiated happy talk.
— James C. Capretta is a fellow at the Ethics and Public Policy Center. He was an associate director atthe Officeof Management and Budget from 2001 to 2004.
Obamacare is not as much on the ropes as you think.
The hospital industry has fully adopted the folly of this legislation. Read the hospital management journals.
The goal of Obamacare is to have full hospital employment of all doctors (easier to control). To that end, hospitals are buying out physician practices, and adopting policies in many cities which has the effect of freezing out private practice physicians.
The hospital management journals are full of such terms such as physician alignment, the medical home, blaming high costs on "fragmented care", and pushing the so called accountable care organization.
The goal is to replace the physician patient relationship with an organization patient relationship. The physician will no longer be bound to the oath to place patient care first. Instead, the organization will monitor physician ordering patterns and force more protocols on physicians, which are based on population guidelines.
If the government protocol works most of the time but saves money, that will be considered a success. If doctors want to keep their jobs, they will not fall outside the guidelines. Patients with difficult medical problems will likely be shuffled around like a hot potato, so as not to screw up the doctor's statistics and, by extension, his or her job.
It is happening now. Obamacare is here. I think the Republicans in Congress know it, and want to run the show...not get rid of it.
The people that truly can see what Obamacare is and how it operates are the Insurance Agents that sell Health Insurance. I work as an Independent Insurance Broker (with access to EVERY company in Washington State) and there are portions of the law randomly "sprung" on us every single month.
Ironically the health insurance plans "Grandfathered" from many of the Obamacare provisions are about 10% to 15% cheaper than the SAME plan right after...it already is costing people more money!
Thanks for this post -- information like this isn't something I come across elsewhere.
I hope you keep posting notes of your daily experiences and observations. Would be nice if NRO would create a bloggish nook where that could be done by you and others on the front lines.
We had better have the exchanges in place, because that's where most of us are going to end up eventually. With a payroll tax of 8% being an employer's cost of choosing not to provide health insurance for its employees, the inexorable tendency will be for all employers whose health care costs exceed 8% to drop coverage and to throw their employees onto the exchanges.
That is just one of the inexorable negative tendencies of Obamacare. Another is what is pejoratively characterized as "gaming the system," i.e., the choice of individuals to go without coverage until a need for medical care arises. With Obamacare's ban on the denial of coverage for pre-existing conditions, the only deterrent to choosing to do without is a payroll tax of 2.% that an individual must pay for making that choice. Most healthy individuals will find that tax not to be a sufficient deterrent. Of course the trend of individuals choosing to go bare until they are in claims-making status will bankrupt private insurance, leaving no one but a single payer -- i.e., an American National Health -- to step into the breech.
The piece touches on another problem with Obamacare: that the administration of its employer mandate, its individual mandate, the availability of Medicaid for everyone up to 130% of the poverty line, and the sliding scale of premium subsidies for everyone between 130 and 300% of the poverty line, will require a massive web of real-time reporting, and Big Brother monitoring, of each worker's wages and his or her health insurance status, on at least month-to-month basis.
With do-gooder schemes like Obamacare the Left always assumes you can just wave a wand and make it so. The fact that every such initiative invariably causes "unintended" consequences -- like employers dropping coverages, individuals going bare, private insurance disappearing, and the inability of a new bureaucracy to keep up -- never registers with the Left. They always seem to think, this time will be different. They're always wrong.
Or maybe if the failure of ACA leads to single-payer, then it was not really a "failure" at all in the eyes of the Democrats who wanted single-payer all along.
Does this mean our choices are "fix ACA implementation problems" or else "single payer"?
I prefer the third option, "repeal ACA and start over"!
There is no reason to help Obama create a fait accompli that leaves us with two bad choices.
If Newt begins to weigh in on, and join the Catholic Bishops in exposing, this latest deceit ObamaCare has dealt an organization Liberals are hostile to (the Catholic Church) while granting waiver after waiver to allies.
That is an excellent line of attack, and the WH handed opponents an issue today:
ACA means everyone has to "join the pool" -- except for labor unions and politically connected corporations who get waivers. And also, Catholic charities aren't allowed to practice Catholicism anymore!
Republican candidates can't make the argument for repeal often enough or strongly enough. It's a disaster on every level -- most crucially it is NOT WORKING AS PROMISED (healthcare costs are still going up, lots of people still lack insurance) -- the only upside is going to rent-seekers with strong lobbying efforts (didn't the big insurance companies help write the bill?)
The downside is a whole lot of "unintended consequences" which just so happen to give the Dems things they couldn't achieve at the ballot box (take over a huge chunk of the economy and force all providers to give taxpayer-funded abortions.) Were they really trying to "fix" healthcare, or was it just a cynical power grab? By the fruits shall ye judge this tree.
So far absolutely nothing is "fixed" -- indeed, it is only getting worse. The first clue was that the law as passed doesn't even take effect for 5 years, because it requires the creation of so much bureaucratic infrastructure to "work" (as if adding more red tape has ever made anything "work better!!!") I think a realistic reform should be implementable almost immediately (and could get some bipartisan support -- remember this ACA was passed with zero Republican votes. It's a very clean cut issue of responsibility.)
Prediction: if there is enough outcry over this, Obama will "waiver" this decision in order to woo back those Catholic groups -- it will be postponed until 2013 or 2014, when he will just proceed with the original plan if he's still in power (the double cross worked the first time right?)
