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.
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.
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.