Senate Finance Committee Chairman Max
Baucus (D-Mont.), one of the chief architects of the Affordable Care Act
(i.e. “Obamacare), won’t seek re-election in 2014, according to two
Democrat sources familiar with the senator’s decision.
This brings to an end his 36-year run in the U.S. Senate.
“I just see a huge train wreck coming
down,” he said, referring to the large number of people who do not
understand how the health care law will work.
IF EVER THERE WAS A VALID ARGUMENT IN FAVOR OF TERM LIMITS, MAX BAUCUS IS IT !!!!!
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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.
Footnotes
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.
About the Author
Tevi Troy is a senior fellow at Hudson Institute and
former deputy secretary of Health and Human Services. This essay is part
of his series for Commentary about the political and legal journey of American health care. His book, What Jefferson Read, Ike Watched, and Obama Tweeted: 200 Years of Popular Culture in the White House, will be published in September.
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