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Friday, March 22, 2013

Obama Health Law a Teetering Toddler

By Chris Stirewalt
“The health care bill is going to provide those medical device companies 30 million new customers. It's going to be great for business. And they're doing really well right now."
-- President Obama in a December interview with Minneapolis’ WCCO defending the tax on medical devices in his 2010 health law.
Senate Democrats had a special third-birthday present for President Obama’s health law, with the majority of them voting to repeal a key tax funding Obama’s signature accomplishment.
And as a result, the president will fly home from the Middle East a bit more of a lame duck than when he left. His fellow Democrats in the Senate sent him off by ditching his demand for a gun ban and will welcome him home with a new controversy over how to fund his much-maligned health-insurance program.
(By the way, those Republicans waiting for Obama to get his party on board with entitlement reductions need to check themselves for irrational exuberance.)
The primary purpose of President Obama’s 2010 health law was to provide a new entitlement program, primarily aimed at lower-middle-class Americans, to provide free or subsidized health insurance.
The law turns three on Saturday and so far, not a single soul has received such a benefit.
The president often points out that more people have health insurance under the law, but those expansions have been part of the mostly uncontroversial expansion of regulations of insurance companies and financed out of the profit margins of those companies. The companies have had to leave 26-year-olds on their parents insurance plans and been forbidden to drop policyholders who breach coverage limits.
The only money that has been spent on the program has been on building the apparatus to administer the program itself. The real costs and benefits won’t kick in until closer to the fourth anniversary of the law.
And now, even before the first American has joined the rolls of what the president now calls Obamacare, the process of undoing the law’s funding and implementation is underway.
What was promised at the time the beleaguered law crashed through the finish line in 2010 was that Americans would come to love the law as they have the insurance entitlement for older Americans, Medicare. When then-House Speaker Nancy Pelosi famously said that Congress had to pass the law for voters to find out what was in it she was trying to make the same argument that had been made more artfully by many other Democrats, including the president.
But because of a lack of legislative know-how and a desperation play to keep a splintering Democratic coalition together, Team Obama produced legislation that was 2,000 pages worth of loopholes, confusion and promises of regulations to be named later. The father of Medicare, Lyndon Johnson, would not have been impressed.
Johnson enrolled the first Medicare beneficiary, former President Harry Truman, immediately after the signing ceremony. It may have been a symbolic gesture, but fast-track implementation followed soon thereafter.
By its third birthday, there were nearly 20 million Americans enrolled in Medicare. Costs were already getting ahead of projections, but with 10 percent of the nation’s population already on the rolls (thanks to the decision to use the existing Social Security system as a means for rapid enrollment) there was no serious talk of unwinding the program.
Even harder to imagine in these days when the federal government can scarcely function, is that while the feds were rolling out Medicare they were also building Medicaid, a welfare program that pays for care of the poor.
Democrats guffawed when House Republicans brought forward a spending plan this year that predicated its balanced budget forecasts on the repeal of Obama’s middle-class entitlement. And no one, including author Paul Ryan believes that the law will be repealed anytime soon.
But is it inconceivable that Obama’s law would eventually be repealed after he leaves office in 2017 or altered so fundamentally that it little resembles the plan shoved through by the president? Hardly.
The law remains generally unpopular. Conservatives don’t like it because it is expensive and intrusive. But they weren’t going to like it anyway. Obama might have his legacy legislation on firmer footing today if he had done what Johnson did and found a program that could garner at least some bipartisan support. But Obama, always in a hurry, rushed into the legislation, saw it stall, and then rushed into final passage through the use of procedural shenanigans in the Senate.
That helps explain why 55 percent of respondents in the latest FOX News poll wanted to repeal all or part of Obama’s health law, almost identical to the number in a poll taken in the fall of 2010.
But what makes Obama’s entitlement vulnerable is that fact that Democrats don’t much like it either.
In a fit of pre-election solidarity, Democrats joined ranks behind the law, which was opposed, in complicated fashion, by the 2012 Republican nominee Mitt Romney. A poll by the Kaiser Family Foundation found 72 percent of Democrats supported the law. Last month, the number was down to 57 percent.
It’s understandable since liberals did not get the law Obama promised and moderate Democrats grew anxious about costs, consequences to the economy and the availability of medical care. And with the actual benefits always just beyond the horizon, no one is attached to the law like they were Johnson’s triumph of 1965.
When 35 members of the Senate Democratic caucus voted to repeal the tax on medical devices like pacemakers and artificial limbs they did so over Obama’s protests and with full knowledge that doing so would make the law more fiscally unsustainable.
The president said that the hardship on medical device makers and their customers would be more than made up for once the law was in full swing and tens of millions more were added to customer rolls with free or partly free insurance. The Senate vote on Thursday night was a very vocal expression of doubt in the president’s promise.
Obama helped himself politically by not implementing his law until after his re-election campaign. Democrats were with him in the promise of goodies yet to come and moderate voters were not put off by the implementation of taxes, regulations and mandates. It was a good way to deal with an unpopular law, just punt that sucker past the election.

So Obama should certainly understand why Democrats would help themselves politically in 2014 and 2016 by whacking away at his legacy law.

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