POLITICS OCTOBER 1, 2013
For several years now, health care policy reporters have been diligently tracking the challenges that were emerging for the Obama administration as it set about implementing the Affordable Care Act. Chief among these was a simple lack of resources to set up what may be the most ambitious and complex expansion of the safety net in American history. Past implementations of health care legislation on a far more modest scale, such as the universal coverage law in Massachusetts and the Medicare prescription drug benefit, enjoyed bipartisan backing for their successful launch. Obamacare, not so much. As the Washington Post reported this past May:
The act included $1 billion to be used in overall implementation of the law. Congressional Budget Office projections, however, estimated that federal agencies will need between $5 billion and $10 billion to get the law up and running over the next decade. And because many states have refused to partner with the federal government in setting up the law, the burden on HHS has grown.
HHS has repeatedly requested additional funds from Congress to assist in the implementation of the law but has been turned down. After Congress rejected a request in March for nearly $1 billion in additional spending for fiscal 2013, the White House asked for $1.5 billion for fiscal 2015 to set up and run dozens of exchanges that will provide Americans options for health insurance. The new marketplaces will launch in October for open enrollment.
"We requested additional money . . . but we didn't receive any additional funding for the exchanges," Ellen Murray, HHS's assistant secretary for financial resources, said last month at a budget briefing. "So we've had to come up with a Plan B. We've been working very hard to develop that."
These warning signs got little airtime in the broader media—from a political reporter’s standpoint, there’s little less appealing than the bureaucratic details of implementing a new domestic policy law. Meanwhile, conservative lawmakers and activists in Washington and the states, with backing from the conservative media, were doing their best to actively undermine the implementation beyond simply denying Health and Human Services Secretary Kathleen Sebelius the funds she needed for a successful launch. They rejected the law’s expansion of Medicaid in nearly two dozen states, harassed the “navigators” hired to help people sign up for coverage, and actively discouraged the uninsured from even taking part, among many, many other hurdles thrown up.
That’s all well and good—if you really believe that the expansion of affordable, well-regulated health insurance is a threat to the republic, then it’s in your interest to hinder its implementation, even if that means coming awfully close to sabotaging the duly legislated law of the land. But if your attempts at undermining the law show some signs of having succeeded when the law makes its debut—if, as we’ve seen today, there are all manner of initial technical glitches in the system rigged up by undermanned bureaucrats working against a constant stream of your resistance—then it’s a bit much to declare that these are proof of the law’s fundamental unworkability.
There is a case to be made that the law, as crafted, is going to be too Rube Goldbergesque to succeed—though making that case honestly requires acknowledging that the law is so complex precisely because it is so moderate (blowing everything up and going with a single-payer system would’ve been simpler.) But one’s standing for making that case is weakened if one has been spending the past few years trying to exacerbate the law’s inherent flaws. If, like some scheming bad guy (or good guy!) in the comic book, you unscrew some parts in your foe’s car, you can claim credit when it crashes into the tree, but you don’t get to declare the car a piece of junk.
But that’s what we were getting on the law's debut day from many of the people who have been rooting and agitating for it to fail from the moment it passed in the spring of 2010. Heritage Action, the political arm of the rightward-lurching Heritage Foundation (which not so long ago came up with the idea of the individual insurance mandate, a centerpiece of the law, but has since disowned the idea and worked hard against the law) tweeted gleefully today about “the glitch error-filled misadventures of creating an account on http://healthcare.gov.” Texas Senator Ted Cruz, leader of the anti-Obamacare troops, tweeted that “Obamacare is one BIG ‘glitch.’” Ben Domenech, a relentless Obamacare-basher at the Heartland Institute chimed in: “Click, click, click, nothing works.” The National Review’s Charles C. W. Cooke chortled: “All websites crash when they are in demand, which is why I can never get onto Google.” Even more mainstream political reporters couldn’t resist taking a swipe. “Heck of a job, Sebelius,” offered National Journal’s Josh Kraushaar.
Schadenfreude is unavoidable in our hyper-partisan time. Still, the level of cynicism on view today is pretty startling. A bunch of anonymous officials in Washington and dozens of states spent the past several years working frantically to ready a system that will, if it works, extend health insurance to more than 30 million Americans. It remains to be seen if they’ll reach their destination—the car’s having some engine trouble out of the gate. And the guys who poured shellac thinner into the gas tank are hiding behind the bushes, laughing their heads off, stifling their guffaws. Hilarious, guys. Hilarious.