OBAMACARE MAY 7, 2013
Democrats are worried about the implementation of Obamacare. And their angst is making news. Today Jackie Calmes of the New York Times reports that Democrats have been peppering the White House with questions—and demanding the administration start putting out more information, so that the law’s critics don’t soak up all of the oxygen on the airwaves. “There’s clearly some concern” among Democrats “that their constituents don’t yet have all facts on how it will work, and that Republicans are filling that vacuum with partisan talking points,” Representative Steve Israel of New York, head of the House Democrats’ campaign committee, told the Times. “And the administration must use every tool they have to get around the obstructions and make it work.”
I happen to think that’s good advice, purely for practical reasons. Implementing the law is a massive enterprise, one that requires the administration to work with officials and organizations across the country. Administration officials know this as well as anybody. They have been thinking about and working on the roll-out ever since Obamacare became law two-and-a-half years ago. But the administration hasn’t done a particularly good job of sharing those plans. In conversations over the last two weeks, about this very question, I’ve been struck by how little even some of the administration’s allies know about what the White House has in mind.
That appears to be changing now. As the Times story noted, the administration just brought on Tara McGuinness, who used to work at the Center for American Progress, to lead a communications team on health care reform. The president himself will start talking more about the law: On Friday, for example, he’ll be giving a speech about the benefits it will bring to women. And much more is in store for the summer, when the administration will inform people about the law's benefits and encourage people who need insurance to sign up. Administration officials need to maintain that kind of campaign. Their allies on Capitol Hill need to start speaking up as well. (Kevin Drum makes that case today, in less gentle terms.)
Political rhetoric has its limits, though. The real test for Obamacare will be how it performs starting this fall, when the new insurance exchanges open for business and people without employer-sponsored coverage start using them to buy insurance. As I’ve written before, even the law’s defenders expect some difficulty for the first few weeks and maybe months—particularly since the administration doesn’t have all of the funding it requested for implementation, and because it is relying so heavily on state officials, many of whom are ambivalent or even hostile to the law. (I’ll have more to say about the likely problems soon.) The people likely to have the roughest time will be the ones who already have it rough: The uninsured and people struggling with the dysfunctional individual insurance market. But the purpose of Obamacare is to make life better for these people, sooner rather than later.
Still, the concern you’re hearing is healthier than the alternative. As Greg Sargent writes, congressional Democrats demanding information about implementation are doing precisely what they should be doing: Performing their constitutional role as oversseers. The same goes for the many federal and state officials who are sitting up at night, sweating over all the things that might go wrong. They're nervous because anybody launching such a large, important initiative should be nervous. Yes, both are also looking out for their own political interests—so what else is new? The tough questions are part of the implementation process as it's supposed to work. My memories of the Iraq War are getting a little fuzzy, so I may be wrong about this, but I don’t recall the Bush administration or its allies fussing so much in public about how the occupation might go.1 Maybe if they had, they would have done a better job.
I'm not trying to draw some equivalence between the Iraq War and Obamacare, obviously. I’m not even saying the Obama administration is handling implementation well. It's too difficult a judgment to make, at least for the moment. But the angst itself doesn't worry me. It might even serve a purpose.
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