Is the White House Passing Obamacare Woes to Hillary Clinton?

By rolling back implementation timelines, Obama is making life all the more difficult for Democrats in 2016.

Former U.S. Secretary of State Hillary Clinton delivers remarks after being presented the 2013 Tom Lantos Human Rights Prize December 6, 2013 in Washington, DC. Clinton received the award for her work in the areas of women's rights and internet freedom. 
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James Oliphant
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James Oliphant
Feb. 13, 2014, 12:47 p.m.

The em­battled Health­Care.gov site fea­tures a time line for im­ple­ment­a­tion of the Af­ford­able Care Act. It ends in 2015.

They wish.

If there was any chance that health care re­form would soon feel more like the law of the land and less like a piñata that gets re­filled and re­hung daily, the White House es­sen­tially put that no­tion to rest this week when it punted the dead­line for me­di­um-sized em­ploy­ers to com­ply with the law yet an­oth­er year.

Now, busi­nesses with 50 to 100 em­ploy­ees have un­til 2016 to of­fer their work­ers af­ford­able in­sur­ance or pay a pen­alty — just about the time pres­id­en­tial primary sea­son is get­ting un­der­way and this pres­id­ent is rendered an af­ter­thought.

The policy ef­fect of the delay on the ACA is min­im­al, most ex­perts say. But in the polit­ic­al battle over Obama­care, now in its fifth smash year, the news was one more in­dic­a­tion that the front has moved to the next pres­id­en­tial elec­tion and bey­ond to the in­com­ing ad­min­is­tra­tion.

The law “will be on the front burn­er in Wash­ing­ton and in every Re­pub­lic­an cam­paign through 2016,” pre­dicts Patrick Dav­is, a GOP con­sult­ant in Col­or­ado.

That elec­tion likely will mark the fourth straight elec­tion cycle in which the ACA is a ma­jor is­sue, if not the cent­ral is­sue — an etern­ity in polit­ics. Call it Obama’s Forever War. “It’s the gift that just keeps giv­ing,” says Douglas Holtz-Eakin, the former chief of the Con­gres­sion­al Budget Of­fice dur­ing the Bush ad­min­is­tra­tion, who launched a con­ser­vat­ive health care think tank last month.

Holtz-Eakin is among many crit­ics who viewed the delay of the em­ploy­er man­date as a means for the White House to avoid ugly head­lines. The re­quire­ment at least raises the pos­sib­il­ity that, faced with the dead­line, busi­nesses will hire few­er full-time work­ers or, more dra­mat­ic­ally, deep-six their health care cov­er­age out­right and dump work­ers in­to the ACA’s in­sur­ance ex­changes.

Sup­port­ers of the law have long in­sisted that won’t hap­pen, but kick­ing the man­date down the road is one way to help en­sure that if that does oc­cur in large de­grees, it might be Hil­lary Clin­ton’s prob­lem, not Pres­id­ent Obama’s.

In the mean­time, the drip-drip-drip of Obama­care’s ups and downs re­mains a pre­oc­cu­pa­tion of both Re­pub­lic­an mes­sage-makers and the Wash­ing­ton press corps. Along with the man­date delay, the last week has seen a furi­ous battle over a CBO re­port about the ef­fects of the law on the labor force and more close-quarter com­bat about the total num­ber of en­rollees on the ex­changes.

The ACA con­tin­ues to de­vour far more polit­ic­al oxy­gen than it should giv­en the re­l­at­ively few Amer­ic­ans it cur­rently af­fects. There was, not that long ago, a thought that the ex­change rol­lout might ce­ment the ACA’s place in the firm­a­ment. But the Health­Care.gov fiasco scrambled that cal­cu­la­tion. Now, says Holtz-Eakin, “there’s no end in sight.”

Polit­ic­ally, the White House and vul­ner­able Demo­crats in Con­gress have rock­ing on their heels ever since. Something like the man­date delay em­boldens Re­pub­lic­ans who be­lieve — wheth­er it’s sound strategy or not — that the law is vul­ner­able to re­newed at­tack.

“Every time the ad­min­is­tra­tion gets cute and thinks they can man­age Obama­care as a polit­ic­al li­ab­il­ity with a delay, they ba­sic­ally en­sure that ac­tion provides Re­pub­lic­ans with yet an­oth­er op­por­tun­ity to drive a con­trast be­fore voters,” says Kev­in Mad­den, a former Mitt Rom­ney ad­viser who now works as a GOP strategist.

Such delays, frets Demo­crat­ic Lead­er­ship Coun­cil founder Al From, re­in­force the view that the fed­er­al gov­ern­ment simply isn’t up the task of work­ing out the de­tails of large-scale re­form, weak­en­ing his party’s ar­gu­ment for con­tin­ued con­trol of the White House. “When people have no faith in gov­ern­ment, they vote Re­pub­lic­an,” he says.

And in an­oth­er sign that the GOP is think­ing about 2016, party lead­ers have been re-tail­or­ing their polit­ic­al mes­sage, us­ing few­er scare quotes to rally the base and fram­ing the ar­gu­ment against the ACA in Re­aganesque phrases about en­ti­tle­ment versus work. Wit­ness Rep. Paul Ry­an’s com­ments last week about the law be­ing a “poverty trap” that robs people of the “dig­nity of work.”

On a policy level, the shaky start means that it will take even longer for the be­ne­fits of the law, in­clud­ing wheth­er the plans avail­able un­der the ex­changes are worth the cost, to re­veal them­selves to the ma­jor­ity of Amer­ic­ans who re­main skep­tic­al.

Two or three years at a min­im­um, says Drew Alt­man, pres­id­ent and CEO of the Kais­er Fam­ily Found­a­tion. “There will be im­ple­ment­a­tion land mines for a very long time” al­low­ing Re­pub­lic­ans to chip away at the law’s found­a­tion by what Alt­man calls “death by an­ec­dote.”

The first bench­mark will come this spring if the ad­min­is­tra­tion fails to meet its own goals for en­roll­ment and for the mix of the young and healthy to the risk pool. While ana­lysts say the make-up of the fed­er­al pool is rather in­sig­ni­fic­ant com­pared with the com­pos­i­tion of state pools, GOP crit­ics won’t hes­it­ate to pounce on the short­fall.

An­oth­er in­volves the now-delayed em­ploy­er man­date. Since em­ploy­ers are not yet re­quired to cer­ti­fy that they of­fer their em­ploy­ees cov­er­age, that means there’s no way to veri­fy wheth­er those work­ers are eli­gible for sub­sidies on the ex­changes. (It’s been called an “hon­or sys­tem.”) That will, Holtz-Eakin says, in­ev­it­ably lead to cases of fraud un­covered by the me­dia.

A third and more po­ten­tially trouble­some flash­point will come closer to midterm Elec­tion Day, when con­sumers and small busi­nesses face an­oth­er round of policy can­cel­la­tions in ad­vance of 2015. Many busi­nesses locked in their 2014 rates early last year in fear of the ACA — and some could ex­per­i­ence steep premi­um hikes. That could dam­age Demo­crat­ic pro­spects for re­tain­ing Sen­ate con­trol at a crit­ic­al time.

It’s a cas­cade ef­fect. A GOP takeover of the Sen­ate would then en­sure Con­gress would be in full anti-ACA mode through the 2016 cam­paign, passing le­gis­la­tion that likely would be ve­toed by Obama. “It guar­an­tees two more years of this,” says Mo El­leithee, spokes­man for the Demo­crat­ic Na­tion­al Com­mit­tee.

Obama­care will haunt Demo­crats in oth­er ways by then. When the White House delayed im­ple­ment­a­tion of the so-called “Ca­dillac” tax on high-dol­lar health care plans to 2018 be­cause of uni­on ob­jec­tions, it en­sured that the next wave of can­did­ates for pres­id­ent will be un­der heavy pres­sure to pledge to re­peal the tax as a con­di­tion for labor sup­port. Do­ing so would re­new cries of fa­vor­it­ism and se­lect­ive en­force­ment that are dog­ging Obama now. The same would hap­pen if the White House de­cides, as some have spec­u­lated, to scrap the em­ploy­er man­date out­right be­fore it does any harm.

And if Clin­ton runs, she’ll have to run as the ar­chi­tect of the in­di­vidu­al man­date, the re­quire­ment that every­one pur­chase health in­sur­ance. (Obama ba­sic­ally co-op­ted that as­pect of her plan.) Should a chal­lenger “take even one step away from the man­date in­side a Demo­crat­ic primary,” Kev­in Mad­den says, “the party would frac­ture.”

None of this means con­tinu­ally ham­mer­ing away at the ACA for the next three years will se­cure the White House for the GOP. El­leithee, nat­ur­ally, sees it as a polit­ic­al loser. And Demo­crat­ic strategist Steve McMa­hon con­tends time is needed for the polit­ic­al nar­rat­ive to be re­writ­ten. “The boo­gey­man stor­ies al­ways seem to punch through,” he says. The law “will get there even­tu­ally.”

Re­mem­ber that ACA timeline? It’s grow­ing longer by the minute.

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