How Obama Keeps Hurting Obamacare

Republicans have huffed and puffed, but it’s the White House that has come closest to blowing the law down.

 People participate in a protest on the second day of oral arguments for the Patient Protection and Affordable Care Act in front of the U.S. Supreme Court building on March 27, 2012 in Washington, DC.
National Journal
Sam Baker
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Sam Baker
Feb. 11, 2014, 3:58 p.m.

Re­pub­lic­ans have done everything they can think of to strike down Obama­care, but they’ve still only man­aged to come in second place. For all the House votes to re­peal, de­fund, or weak­en Obama­care, some of the most sig­ni­fic­ant set­backs for the law have come from the ad­min­is­tra­tion it­self.

Monday’s delay in the law’s em­ploy­er man­date was just the latest in a series of self-in­flic­ted wounds, just like the Health­Care.gov launch and delays in sev­er­al pro­grams that simply wer­en’t ready for prime time.

To be clear, the self-in­flic­ted wounds haven’t been fatal. Obama­care is mov­ing for­ward — and the doom­say­ers’ proph­ecies have fallen flat: People are sign­ing up, premi­ums are lower than ex­pec­ted, and the law’s ba­sic sur­viv­al is as­sured. It gets stronger every month as more people pour in­to new in­sur­ance mar­ket­places in each state.

But the law does have a spe­cif­ic vis­ion of the fu­ture of health in­sur­ance. And to hit that vis­ion, it re­lies on a del­ic­ate bal­ance of pop­u­lar car­rots — think cov­er­age for those with preex­ist­ing con­di­tions — and un­pop­u­lar sticks, such as the ever-con­tro­ver­sial in­di­vidu­al man­date. And the ad­min­is­tra­tion keeps chip­ping away at un­pop­u­lar parts — some­times dir­ectly, and some­times by hand­ing Re­pub­lic­ans a polit­ic­al weapon.

From a policy per­spect­ive, an­oth­er delay in the em­ploy­er man­date is neg­li­gible. The man­date doesn’t cov­er very many people. But it gave an­oth­er big open­ing to con­gres­sion­al Re­pub­lic­ans, who ar­gued — as they did the first time — that big busi­ness was get­ting a break while in­di­vidu­als were still re­quired to buy in­sur­ance.

“A les­son we’ve learned from the im­ple­ment­a­tion pro­cess is that, while the Af­ford­able Care Act will im­prove health se­cur­ity and open op­por­tun­it­ies for every Amer­ic­an, it makes sense that some of the changes ushered in by the law be phased in over time to smooth the trans­ition,” a seni­or ad­min­is­tra­tion of­fi­cial said.

Even many lib­er­al policy wonks wish the em­ploy­er man­date wasn’t part of the health care law to be­gin with. But it is — largely be­cause many Demo­crats thought it was the only way someone work­ing 30 or 35 hours per week was go­ing to get health in­sur­ance without the gov­ern­ment pay­ing for it.

Now that goal is tem­por­ar­ily on hold — as is a new on­line mar­ket­place for small busi­nesses. Next year’s open-en­roll­ment win­dow has been delayed to make up for prob­lems with this year’s. A new health care plan for low-in­come people, known as the Ba­sic Health Plan, was also pushed back a year. Then there’s the CLASS Act, a long-term care pro­gram the White House simply couldn’t im­ple­ment be­cause it was de­signed so poorly. And the Health­Care.gov launch.

None of these mis­steps was fatal to the law, and ul­ti­mately what mat­ters is people sign­ing up. But Demo­crats’ vis­ion for the Af­ford­able Care Act is far more likely to hap­pen if they keep con­trol of the Sen­ate this year, and the seem­ingly end­less string of im­ple­ment­a­tion set­backs is mak­ing that harder.

If phas­ing in the em­ploy­er man­date in­vited a polit­ic­al head­ache in or­der to make a policy work more smoothly, some of the law’s sup­port­ers are more wor­ried about the flip side: un­der­cut­ting the policy to try to calm a polit­ic­al storm.

Aet­na’s CEO said last week that the ad­min­is­tra­tion might ex­tend a policy al­low­ing some people to keep health care plans that were can­celed be­cause of the Af­ford­able Care Act. The De­part­ment of Health and Hu­man Ser­vices re­portedly con­firmed that op­tion is on the table.

Even the law’s most pas­sion­ate de­fend­ers won’t de­fend the “like it/keep it” policy — much less ex­tend it. Can­celed in­sur­ance policies, again, were not a side ef­fect. Obama­care sets new stand­ards for in­di­vidu­al in­sur­ance policies and tries to move people in­to plans that meet those stand­ards — es­pe­cially the healthy people who got a good enough deal to want to keep their old, can­celed plan.

Un-can­celing plans has a mod­est but neg­at­ive ef­fect on the law’s new ex­changes. It keeps healthy people out of the sys­tem, in­creas­ing the odds of premi­um hikes. When the White House first an­nounced that it would let in­surers un-can­cel cer­tain plans, many lib­er­al policy ex­perts said the law would work fine if Demo­crats would leave it alone — and that’s still their be­lief.

“I hope the White House doesn’t do that,” said Timothy Jost, a law pro­fess­or at Wash­ing­ton and Lee Uni­versity and an ar­dent Obama­care sup­port­er. “I think Con­gress meant to move on.”

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