Here Comes Obamacare

WASHINGTON — Although many of its rules will not take effect for months, President Barack Obama’s health-care law already is the subject of an aggressive advertising campaign by Republicans to sow doubts about how it will work.

In one of the largest campaigns of its kind, Americans for Prosperity, a conservative advocacy group financed by billionaires Charles and David Koch, will begin running TV commercials this week asserting that the law will limit Americans’ health-care choices.


www.dispatch.com/content/stories/national_world/2013/07/07/conservative-ads-bash-obamas-law.html

My colleague Matthew Yglesias is up with a classic SlatePitch: A collection of evidence that implementing Obamacare will go just fine in the states that are actually trying to implement it. His hook is the idea that implementation will be a "train wreck." This might be a good time to explain where that quote came from, and enjoy the ways it's been mutilated by the press.


So: On April 17, the Senate Finance Committee called HHS Secretary Kathleen Sebelius to testify on implementation and other issues. Montana Sen. Max Baucus, the chairman of the committee, one of the fathers of Obamacare, raked Sebelius over the coals about a decision that cut the PR budget for implementation. The administration requested $554 million for PR. House Republicans, understandably, cut the entire budget for implementation. The fiscal cliff deal slashed the overall spending on the Prevention and Public Health Fund from $15 billion (over 10 years) to $10 billion. So Sebelius moved money out of PR and promotion and tried to make up that money by asking health care companies to chip in.


That ask became an outrage all its own. That was the context in which Baucus asked Sebelius how HHS was possibly able to educate patients and providers about a new law that was deeply confusing.



"A lot of people have no idea about all of this," he said. "People just don't know a lot about it, and the Kaiser poll pointed that out. I understand you've hired a contractor. I'm just worried that that's gonna be money down the drain because contractors like to make money ... I just tell ya, I just see a huge train wreck coming down."


What would cause the "train wreck"? Insufficient awareness of how the law worked. Not the law itself. Neither at that hearing nor in the month since has the (always pretty mush-mushed) Baucus said the law itself would be a disaster if implemented.


But that's how Republicans used the quote. In a column by Baucus' former colleague John Sununu:


Baucus led the effort to craft and pass Obamacare through the Senate. So it made news last month when he called the health care law “a huge train wreck coming down.” His candor reflects the reality he sees on the ground. The federal government has just four months before an October deadline to design and implement online insurance exchanges to serve 20 million people across 34 states. It is woefully behind schedule.


In a speech by Baucus' current colleague Mike Johanns:


I'm certain that you've seen stories in the last few weeks about the difficulty expected in implementing President Obama's health care law. One of the bill's authors, in fact, Senator Max Baucus, said the law's implementation would lead to a train wreck, to use his words. Majority Leader Reid agreed with him.



Reid actually agreed that it would be a "train wreck" only if it wasn't promoted the right way, but whatever, this was from Mitch McConnell:


What's happening here is that everything Senate and House Republicans predicted with regard to Obamacare is coming true. Jobs are being lost. Premiums are going up. If you have a health insurance policy that you like, you're not going to get to keep it. The chances are you will lose it. This is, as the chairman of the Finance Committee said, "a train wreck."


It wasn't just Republicans expanding a quote about PR and implementation to cover every aspect of implementation. In an April 30 press conference question from NBC News' Chuck Todd:


Max Baucus, Democratic Senator, referred to the implementation as your health care law as a potential train wreck. And other Democrats have been whispering nervousness about the implementation and the impact -- and it’s all self-centered a little bit -- the impact that it might have on their own political campaigns in 2014. Why do you think -- just curious -- why does Senator Baucus, somebody who ostensibly helped write your bill, believe that this is going to be a train wreck?



Sean Hannity has gnawed on the "train wreck" line like a starving dog who found a soup bone. On April 30:



Mr. President, Obamacare implementation is, to quote Democratic Senator Max Baucus, "it's a train wreck." And here's a prediction, the disastrous effects of Obamacare will be a huge and hugely negative factor for Democrats in the 2014 midterm elections.


On May 3:


Keep in mind that even when the president is able to implement a piece of his radical agenda, it doesn't always work out the way he planned. Take, for example, Obamacare. Now the liberal law that has now has Democrats calling it a, quote, "train wreck." Even Harry Reid uttered the agreement in that statement.
 

Even Charlie Rose got into it on May 17, asking panelists about implementation: "Does everybody, in the words of Max Baucus, consider this a train wreck?" It was conventional wisdom—even the author of Obamacare said the law would be a train wreck if implemented.


This is a useful study of the power of misapplied quotes. There are plenty of stories about Obamacare implementation gone wrong. Start with the saga of the Pre-Existing Condition Insurance Plan, expected to enroll 400,000 people at a cost of $5 billion. They're a third of the way there and the money's running out. But Baucus was trying to say that implementation could work if the promotional budget wasn't cannibalized or squandered. That's been lost to a far sexier story built on a misunderstood quote.

www.slate.com/blogs/weigel/2013/05/24/the_secret_history_of_max_baucus_s_train_wreck_quote.html

But other analysts said the delay could cause more workers to lose their health care coverage.

“The policy implications are fairly straightforward. Essentially for calendar 2014 the act of dropping coverage and dumping employees into the exchanges is on sale,” said Douglas Holtz-Eakin, former director of the Congressional Budget Office and now president of the American Action Forum. “Drop and dump, but no penalty.”

Workers hoping the law would compel their employer to start offering a medical policy next year may still be eligible to buy subsidized coverage directly from insurers through online marketplaces. Those exchanges will still be open for enrollment Oct. 1, the administration said.

For larger employers, the delay provides more time to work through complicated regulations issued by the Internal Revenue Service and the Department of Health and Human Services.

“The IRS has been good about putting out information, but it’s an enormous task to get it up and running, even with guidance,” said J.D. Piro, who heads the health law group at benefits consultant Aon Hewitt. The announcement, he said, “gives employers a lot more time to ask these questions and get their systems in place.

Of particular concern were rules determining which companies and workers are subject to the employer mandate. The definitions of what constitutes a 50-employee firm and who qualifies as a full-time staffer who is owed coverage were subject to considerable debate and analysis.

“I’m amazed at how the employers I’ve talked to have been struggling with how to react to the employer requirement,” Levitt said. “Even very large companies might have different definitions for part-time workers than what’s in the law.”

Some employers have reportedly been downsizing, increasing hires of temporary workers and cutting hours in an effort to avoid coverage requirements. Others have shifted to self-insured status — in which the company pays the medical bills directly — to avoid benefit requirements and taxes applying to insurance plans.

The announcement does not affect the ACA’s essential health benefits required to be offered by small employers. Companies with fewer than 50 workers aren’t obliged to offer coverage under the ACA. But if they do, and they aren’t among a minority of older, “grandfathered” plans, then they must offer minimum benefits with new price regulations that could drive up premiums.

“A lot of these small employers are thinking of dropping coverage because it is being priced much higher,” said Robert Laszewski, an industry consultant and former insurance executive. “Which begs the question: Why are large employers getting a pass for a year (from the coverage requirement) and small employers are not?”

Analysts said there also may be problems determining eligibility for insurance subsidies in the form of tax credits.

“If employers have no obligation to report coverage, how will the exchanges or the IRS verify claims that coverage is unaffordable or inadequate?” said Timothy Jost, a law professor at Washington and Lee School of Law. “Could this potentially mean that many more individuals will become eligible for premium tax credits, either because their employers drop or do not expand coverage, or fail to respond to requests to verify coverage?”

Read more: swampland.time.com/2013/07/03/delay-in-obamacare-law-provision-raises-doubts-at-critical-stage-of-rollout/#ixzz2YbhrLoNg