Obama Invokes the Ghost of Mitt Romney

The administration apparently learned nothing from Romneycare’s initial missteps — as demonstrated in HealthCare.gov’s feckless debut.

President Barack Obama (R) shakes hands with Republican presidential candidate Mitt Romney after the debate at the Keith C. and Elaine Johnson Wold Performing Arts Center at Lynn University on October 22, 2012 in Boca Raton, Florida.
National Journal
Major Garrett
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Major Garrett
Oct. 30, 2013, 12:24 p.m.

BO­STON — De­fens­ive and de­luged by skep­ti­cism and cri­ti­cism, Pres­id­ent Obama on Wed­nes­day brought his battered health care law to one of the Bay State’s best-known turn­around artists.

Mitt Rom­ney.

Not that Obama’s van­quished 2012 rival will be here for the pep rally. The White House didn’t in­vite Rom­ney, and he prob­ably wouldn’t have come even if offered a lift on Air Force One. Aboard that plane, White House spokes­man Josh Earn­est said that “suc­cess­ful im­ple­ment­a­tion of health care re­form in Mas­sachu­setts is an as­pect of Gov­ernor Rom­ney’s leg­acy that he should jus­ti­fi­ably be proud of.”

So Rom­ney will be a dis­em­bod­ied re­mind­er that Obama­care can be saved from its feck­less Health­Care.gov web­site de­but, its un­der­whelm­ing num­ber of ac­tu­al en­rollees (most right now are in Medi­caid, not private in­sur­ance), and out­rage among those in the in­di­vidu­al in­sur­ance mar­ket who now have to switch their policies after be­liev­ing Obama when he said they could keep them. For his part, Rom­ney said in a state­ment that suc­cess here was due in part to “care­fully phas­ing … in” the most cum­ber­some and eco­nom­ic­ally dis­rupt­ive parts of the law.

Rom­ney, you see, turned the Mas­sachu­setts health care law around. At its launch, the law had sev­er­al prob­lems. One was col­lect­ing af­ford­able premi­um bids for min­im­um in­sur­ance cov­er­age and forced in­surers to come up with lower-cost al­tern­at­ives (res­ult­ing in av­er­age monthly premi­ums of $175 per month versus the ini­tial es­tim­ates of $380 per month).

The plan also had tiny early-en­roll­ment num­bers and garbled reg­u­la­tions. Some parts of the law (sub­sidies for low-in­come re­cip­i­ents at or slightly above the poverty line and un­sub­sid­ized small-busi­ness cov­er­age) had to be delayed for prop­er im­ple­ment­a­tion. Over time, en­roll­ment num­bers came in, reg­u­la­tions were un­snarled, and pub­lic sat­is­fac­tion in 2012 reached 62 per­cent.

Obama will say the Mas­sachu­setts law got off to an un­in­spir­ing start but everything even­tu­ally worked out.

Mi­chael Duka­kis had his Mas­sachu­setts Mir­acle. Obama has a Mas­sachu­setts Muddle.

“Your law was the mod­el for the na­tion’s law,” Obama said in his speech Wed­nes­day. “This new [na­tion­al in­sur­ance] mar­ket­place was built on the Mas­sachu­setts mod­el.”

Obama ad­ded he was “not happy about” the balky fed­er­al health care web­site. “We’re go­ing to get these prob­lems re­solved. Those plans are wait­ing.”

Ex­cept health care costs did not de­cline in Mas­sachu­setts, and neither did med­ic­al-re­lated bank­ruptcies — stated goals of both Rom­ney­care and Obama­care.

More telling, Obama will have to ar­gue that Mas­sachu­setts mat­ters be­cause com­plic­ated things are hard and prob­lems arise. Fine. But that also be­trays a harsh truth: The ad­min­is­tra­tion ap­par­ently learned noth­ing about the front-end polit­ic­al and policy haz­ards that Mas­sachu­setts con­fron­ted, or the gradu­al­ism re­quired to im­ple­ment the law. That means it was will­fully ig­nor­ant of or in­dif­fer­ent to the an­ti­cip­ated dif­fi­culties of tak­ing a com­puls­ory state-in­sur­ance pro­gram na­tion­wide. In the med­ic­al com­munity, this has a name: mal­prac­tice.

The biggest prob­lem for Obama now is the chasm between his prom­ise to Amer­ic­ans that Obama­care would al­low them to keep their in­di­vidu­al-in­sur­ance policy and the real­ity of can­cel­la­tion no­tices for mil­lions in this mar­ket.

It’s a com­plex top­ic, and the White House is prac­tic­ally beg­ging for “con­text” to di­lute the wrath of Amer­ic­ans who bought cov­er­age, liked it, and thought they could keep it. There is no clari­on of polit­ic­al dis­tress louder or clear­er than the plaint­ive cry for “con­text.”

In this pur­suit, I spoke with Dav­id Si­mas, one of Obama’s top health care ad­visers, about this dis­con­nect.

When the pres­id­ent said, as re­cently as March, if you have your plan and you like your plan, you can keep your plan, was he mean­ing un­less your in­sur­ance com­pany changes it?

Here’s the per­spect­ive on the in­sur­ance mar­ket: 80, 15, and 5. Eighty per­cent of Amer­ic­ans have their cov­er­age either at work, in Medi­caid, or in Medi­care, and so the Af­ford­able Care Act just en­hances their be­ne­fit. Fif­teen per­cent of people are un­in­sured, and they get the new be­ne­fits of the Af­ford­able Care Act. What we’re talk­ing about, Ma­jor, are those 5 per­cent of people who are in the in­di­vidu­al mar­ket.

Roughly 14 mil­lion Amer­ic­ans.

Between 11 and 14 mil­lion Amer­ic­ans in what has been com­monly re­ferred to pri­or to the ACA as the Wild West of in­sur­ance mar­ket­ing, and that was the case be­cause if folks had preex­ist­ing con­di­tions, they could be denied; if you were a wo­man, you could be charged double…. So what the Af­ford­able Care Act did that was very clear was that it grand­fathered plans.

So those plans came in as-is.

At that time, right. Here’s what happened from that point for­ward: If there is a per­son who was on that plan when the law passed, there’s been no change to the plan, they have stayed in it, that plan doesn’t change, there’s noth­ing dif­fer­ent about that plan.

Now, if you left the plan and went in­to a new plan that came on­line after the Af­ford­able Care Act, there are a whole bunch of new be­ne­fits and pro­tec­tions that ap­ply to it. If your in­sur­ance com­pany after the fact star­ted mak­ing changes to the plan — as had been the case pri­or to the Af­ford­able Care Act when people could be dropped, their premi­ums in­creased, or they could be un­der­writ­ten — then those plans need to have the new min­im­um be­ne­fit pro­tec­tions that the Af­ford­able Care Act had in place.

At the end of the day, what the Af­ford­able Care Act did, which was sig­ni­fic­ant and is sig­ni­fic­ant, is go­ing to be for those 11 to 14 mil­lion people who have been un­der­writ­ten. One in five people who even ap­plied for cov­er­age on the in­di­vidu­al mar­ket were denied be­cause of a preex­ist­ing con­di­tion; one out of two people un­der 65 were sub­ject to dis­crim­in­a­tion in terms of preex­ist­ing con­di­tions; wo­men were charged more; if you were older, what are called the rat­ing bans were pretty ex­cess­ive. All of that goes away.

Part of your ef­fort to erad­ic­ate what you call the Wild West.

That’s ex­actly right.

And the long arm of the fed­er­al gov­ern­ment is re­quired to erad­ic­ate that Wild West.

Well, look, it’s not in terms of a long arm of the fed­er­al gov­ern­ment, it’s about cer­tain ba­sic con­sumer pro­tec­tions that people should ex­pect. When you sign on for a plan, it’s clear what you’re re­ceiv­ing. The mo­ment you get sick, you’re not dropped. If you think that you’re go­ing to have cov­er­age, all of a sud­den you don’t see fine print that says, “Oh, I’m sorry, but we only cov­er the first $500,000 of cov­er­age.”

For the Amer­ic­ans who have re­ceived these no­tices and it says here’s a policy that’s more ex­pens­ive than the one you had, and they sit at their kit­chen table and say “I heard the pres­id­ent tell me I could keep this plan, now I can’t,” you tell them what? “Blame your in­surer” or “blame Obama­care?”

Pri­or to the pas­sage of the Af­ford­able Care Act, people like that fam­ily were get­ting that let­ter year in and year out but then didn’t have any re­course. Here’s the re­course that they have today: First, they have com­pet­i­tion and choice, they can look at that let­ter from their in­sur­ance com­pany or they can look for al­tern­at­ives. Second, they can get tax cred­its that they didn’t have be­fore that drive down the cost of their in­sur­ance. Third, if they’re a wo­man, they’re no longer sub­ject to double premi­ums, and the same thing with seni­or cit­izens.

They can find all that out on the web­site, once the web­site starts work­ing bet­ter.

They can go to Health­Care.gov, they can go to the 1-800 num­ber, they can go in per­son to one of the folks in our com­munity health cen­ters and nav­ig­at­ors, they can go to their own state, [such as] Covered Cali­for­nia, if they hap­pen to live in one of the state-based mar­ket­places. Here’s the bot­tom line: It’s a six-month open-en­roll­ment peri­od, and those in­di­vidu­als now have some choice, com­pet­i­tion, bet­ter cov­er­age, [and] min­im­um con­sumer pro­tec­tions.

But for the stick­er shock [of high­er premi­ums] they should blame the in­sur­ance com­pany, not Obama­care?

In terms of stick­er shock, here’s the thing that each and every fam­ily needs to see first: Am I eli­gible for tax cred­its? Second, is there a dif­fer­ent in­sur­ance com­pany that’s of­fer­ing me a bet­ter rate? For the over­whelm­ing per­cent­age of people on the in­di­vidu­al mar­ket, who are go­ing to be re­ceiv­ing let­ters like this that move them in­to new cov­er­age, that’s go­ing to be the facts on the ground for them.

*   *   *

Obama is grop­ing awk­wardly for Rom­ney’s “facts on the ground” here. But that’s a one-trick pony, a the­at­ric­al place­hold­er de­signed to buy time and coun­ter­bal­ance Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us’s web­site apo­lo­gia.

The true facts on the ground are shak­ing pub­lic con­fid­ence — already brittle — in Obama­care’s many prom­ises. The in­di­vidu­al mar­ket story will have many turns, but the early re­views are de­cidedly neg­at­ive, and if en­roll­ment num­bers don’t meas­ure up, Obama will wish his biggest prob­lem was a balky web­site.

In his win­dup here in Bo­ston on Wed­nes­day af­ter­noon, Obama said he will nev­er give up on im­ple­ment­ing the law. “We will grind this out. We will see this through. One and in­sep­ar­able.” That’s two parts truth and one part silly sen­ti­ment­al­ity. The only thing in­sep­ar­able from Obama­care is en­trenched hos­til­ity. Obama has known that from the start. And that’s made the grind­ing more dif­fi­cult than it should have been. Any­one here could have told him that.

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.

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