Obama’s Arbitrary Health Care Flexibility

In the Affordable Care Act’s never-ending revisions, the only pattern is chaos.

WASHINGTON, DC - JANUARY 31: U.S. President Barack Obama delivers remarks about his plans to help America's long-term unemployed during an event in the East Room of the White House January 31, 2014 in Washington, DC. During the event Obama signed a memorandum directing the federal government not to discriminate against long-term unemployed job seekers. 
Getty Images
Major Garrett
Add to Briefcase
Major Garrett
Feb. 11, 2014, 5:12 p.m.

The Af­ford­able Care Act means what it says and says what it means.

Un­til it doesn’t.

The ar­bit­er is Pres­id­ent Obama and a phalanx of health care ad­visers and polit­ic­al strategists.

To­geth­er, they try to im­ple­ment what even Obama’s hearti­est loy­al­ists con­cede is an oner­ous and com­plic­ated law. They do this amid myri­ad Demo­crat­ic midterm anxi­et­ies. And frothy Re­pub­lic­an ob­jec­tions.

But it’s time to con­cede that no one has been more ad­ept or ag­gress­ive about delay­ing and de­fanging Obama­care than Obama him­self. Sys­tem­at­ic­ally and with an eye to­ward his party’s im­me­di­ate polit­ic­al troubles, Obama has re­shaped, photo-shopped, re­ima­gined, and reen­gin­eered Obama­care. It all sounds techy and cool and flex­ible — at least to the ad­min­is­tra­tion. To those who must live with and live un­der the law, the ar­bit­rary is the norm. The only pat­tern is chaos. Obama­care’s worst en­emy is Obama.

The New York Times has com­piled a help­ful list of re­cent changes to the Af­ford­able Care Act — 13 in just over a year. That comes out to more than one sub­stant­ive change to policy or le­gis­lated dead­lines per month. This, in a land­mark law near­ing its fourth birth­day.

The latest switch­eroo deals with the em­ploy­er man­date, which the ad­min­is­tra­tion has delayed for an­oth­er year for me­di­um-sized busi­nesses and softened for big em­ploy­ers. Com­pan­ies with 50 to 99 em­ploy­ees will not have to provide health in­sur­ance un­der fear of fines (between $2,000 and $3,000 per full-time em­ploy­ee) un­til Janu­ary 2016. Un­til Monday, the dead­line was Janu­ary 2015. Also, com­pan­ies with more than 100 em­ploy­ees can provide in­sur­ance cov­er­age to just 70 per­cent of their work­force in 2015 in­stead of the ori­gin­al 95 per­cent re­quire­ment.

The em­ploy­er man­date is a sig­ni­fic­ant com­pon­ent of the law that was sub­ject to strenu­ous the­or­et­ic­al de­bate in the 2008 pres­id­en­tial cam­paign and lengthy le­gis­lat­ive tuss­ling dur­ing the draft­ing of Obama­care. This is a not an Af­ford­able Care as­ter­isk, al­though health care eco­nom­ists ar­gue it has little im­pact on in­creas­ing in­sur­ance cov­er­age.

That may be true, but it drove me­di­um-sized busi­nesses to dis­trac­tion, and they lob­bied the White House for a re­prieve — and won the midterm polit­ic­al lot­tery.

Obama de­scribed the change sooth­ingly in his joint press con­fer­ence with French Pres­id­ent François Hol­lande. “This was an ex­ample of, ad­min­is­trat­ively, us mak­ing sure that we’re smooth­ing out this trans­ition, giv­ing people the op­por­tun­it­ies to get right with the law, but re­cog­niz­ing that there are go­ing to be cir­cum­stances in which people are try­ing to do the right thing and it may take a little bit of time,” Obama said.

It may take a little bit of time.

El­ev­en of the 13 al­ter­a­tions to the Af­ford­able Care Act in the past 12 months have giv­en in­di­vidu­als or busi­nesses more time. The bur­den of com­pli­ance is palp­able. And so the White House has had to again and again smooth out the trans­ition, in a law it craf­ted ex­clus­ively with Demo­crats.

“Our goal here is not to pun­ish folks,” Obama said, un­wit­tingly ad­mit­ting that com­pli­ance with his own law amounts to eco­nom­ic and ad­min­is­trat­ive sanc­tion. “Our goal is to make sure that we’ve got people who can count on the fin­an­cial se­cur­ity that health in­sur­ance provides.”

Of course, those em­ploy­ees who work for com­pan­ies that just hap­pen to have 50 to 99 em­ploy­ees and were hop­ing, pos­sibly ex­pect­ing, to re­ceive health cov­er­age next year — well, they can­not count on Obama­care. Or Obama, who help­fully ex­plained why:

“Where we’ve got com­pan­ies that want to do the right thing and are try­ing to work with us, we want to make sure that we’re work­ing with them as well.” Trans­la­tion: If you want to provide cov­er­age but not right now and in com­pli­ance with the law as writ­ten, and you com­plain loud enough and weak­en the polit­ic­al foot­ing of Sen­ate Demo­crats, you don’t have to eat your Obama­care spin­ach — or cov­er your em­ploy­ees.

In the same breath, Obama made clear that this pro­cess of photo-shop­ping, re­writ­ing, and re­ima­gin­ing will con­tin­ue apace, de­pend­ing on the hassle that is Obama­care com­pli­ance and the polit­ic­al ter­rain.

“That’s go­ing to be our at­ti­tude about the law gen­er­ally: How do we make it work for the Amer­ic­an people and for their em­ploy­ers in an op­tim­al sort of way?”

Op­tim­al.

How would you like to work for a com­pany (more than 115,000 of them in 2012) that you thought would have to provide health care cov­er­age for you next year but now won’t? And how would you like to be one of the em­ploy­ees who works for a big com­pany (more than 94,000 of them in 2012) but falls just on the oth­er side of the 70 per­cent cov­er­age threshold in 2015? Your health falls on the oth­er side of Obama’s ar­bit­rary cov­er­age line, and you don’t have cov­er­age.

I’m will­ing to bet “op­tim­al” is not the word that will come read­ily to mind.

For Obama, it’s all about flex­ib­il­ity. He was asked if the Af­ford­able Care Act would ush­er in the end of em­ploy­ee-based in­sur­ance in Amer­ica.

“I don’t think that an em­ploy­er-based sys­tem is go­ing to be, or should be, re­placed any­time soon,” Obama said.

Con­sid­er­ing the cre­at­ive clock-man­age­ment and time-ma­chine qual­ity of Obama­care im­ple­ment­a­tion to date, “any­time soon” sounds al­most wist­ful. For Obama, that is, not ne­ces­sar­ily for em­ploy­ees who have care they like and want to keep (yes, that phrase still mat­ters … and will mat­ter more as Obama­care’s reg­u­lat­ory reach be­comes fully mani­fest).

“What the Af­ford­able Care Act does do is, it gives people some flex­ib­il­ity.”

But which people? And why?

There is no op­tim­al an­swer.

The au­thor is Na­tion­al Journ­al Cor­res­pond­ent-at-Large and Chief White House Cor­res­pond­ent for CBS News. He is also a dis­tin­guished fel­low at the George Wash­ing­ton Uni­versity School of Me­dia and Pub­lic Af­fairs.

What We're Following See More »
INDICTMENTS NOT PROOF OF COLLUSION
Rosenstein Holds Presser On Russian Indictments
1 days ago
THE DETAILS
Source:
CONTRADICTS TRUMP’S DENIALS
U.S. Indicts 13 Russian Nationals For Election Interference
1 days ago
THE LATEST

The indictment, filed in the District of Columbia, alleges that the interference began "in or around 2014," when the defendants began tracking and studying U.S. social media sites. They "created and controlled numerous Twitter accounts" and "purchased computer servers located inside the United States" to mask their identities, some of which were stolen. The interference was coordinated by election interference "specialists," and focused on the Black Lives Matter movement, immigration, and other divisive issues. "By early to mid-2016" the groups began supporting the campaign of "then-candidate Donald Trump," including by communicating with "unwitting individuals associated with the Trump Campaign..."

Source:
“QUEEN FOR A DAY”
Gates Said to Be Finalizing a Plea Deal
1 days ago
THE LATEST

"Former Trump campaign adviser Rick Gates is finalizing a plea deal with special counsel Robert Mueller's office, indicating he's poised to cooperate in the investigation, according to sources familiar with the case. Gates has already spoken to Mueller's team about his case and has been in plea negotiations for about a month. He's had what criminal lawyers call a 'Queen for a Day' interview, in which a defendant answers any questions from the prosecutors' team, including about his own case and other potential criminal activity he witnessed."

Source:
ZERO-FOR-TWO
Another Defeat for Immigration Legislation in the Senate
2 days ago
THE LATEST

"The Senate on Thursday rejected immigration legislation crafted by centrists in both parties after President Trump threatened to veto the bill if it made it to his desk. In a 54-45 vote, the Senate failed to advance the legislation from eight Republican, seven Democratic and one Independent senators. It needed 60 votes to overcome a procedural hurdle. "

Source:
DISPUTE ASSERTION OF EXECUTIVE PRIVILEGE
House Intel Panel Could Charge Bannon with Contempt
2 days ago
THE LATEST

"The House Intelligence Committee has scheduled a Thursday meeting to hear testimony from Steve Bannon—but it's an open question whether President Donald Trump's former chief strategist will even show up. The White House sent a letter to Capitol Hill late Wednesday laying out its explanation for why Trump's transition period falls under its authority to assert executive privilege, a move intended to shield Bannon from answering questions about that time period." Both Republicans and Democrats on the committee dispute the White House's theory, and have floated charging Bannon with contempt should he refuse to appear.

Source:
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login