Fumbling Obamacare

[Arkady]

I was always skeptical of the Affordable Care Act. Put it this way: if you took the forty richest countries in the world and arrayed our healthcare systems from most to least socialized, the US would come out as the very least socialized, with an appreciable margin between itself and the next-closest country... and that's AFTER Obamacare is finally completely phased in. It was a reform built around the goal of preserving corporate profits -- a reform designed by the conservative think tank the Heritage Foundation, and previously championed by Republican standard-bearer Mitt Romney. Yet, despite it essentially being a Republican package that would leave us as an outlier among advanced nations, I supported passage because I thought it was at least a small step in the right direction. Unfortunately, Obama seems intent on making it an even smaller step, or at least a slower one.

First Obama delayed implementation on the rules about businesses providing insurance. Now he's delaying implementation on the rules about maximum levels people can be required to spend:

http://www.salon.com/2013/08/13/another_obamacare_setback/

I get that this is a big, complicated reform, but how did Obama fail to get his ducks in a row after all this time? The whole point of the painfully slow roll-out (it became law well over three years ago) was to provide ample time for implementation. How is it that Obama feels he needs to provide big insurers and companies even more time to adapt to changes they've seen coming since 2008, and that they knew about definitively since early 2010?

From the perspective of the little guy, these delays are a disaster. The Mandate is going into effect (the little guy doesn't have a high-priced lobbyist to buy a one year reprieve from the Obama team), but the things that made the Mandate palatable (employer mandates and price controls for some insurers), will be delayed. The opposite pattern could have been explained more easily --delaying the mandate for individuals by a year, while forcing the big companies to comply with the original timeline-- since the big companies have the expertise and resources not to have been taken by surprise by any of this. But insisting on a strict timeline for the little guy while powerful corporations get the rules bent is the kind of thing you see when money is running the show.

 

[ITALIA]

I was always skeptical of the Affordable Care Act. Put it this way: if you took the forty richest countries in the world and arrayed our healthcare systems from most to least socialized, the US would come out as the very least socialized, with an appreciable margin between itself and the next-closest country... and that's AFTER Obamacare is finally completely phased in. It was, after all, a reform built around the goal of preserving corporate profits -- a reform designed by the conservative think tank the Heritage Foundation, and previously championed by Republican standard-bearer Mitt Romney. Yet, despite it essentially being a Republican package that would leave us as an outlier among advanced nations, I supported passage because I thought it was at least a small step in the right direction. Unfortunately, Obama seems intent on making it an even smaller step.

First Obama delayed implementation on the rules about businesses providing insurance. Now he's delaying implementation on the rules about maximum levels people can be required to spend:

http://www.salon.com/2013/08/13/another_obamacare_setback/

I get that this is a big, complicated reform, but how did Obama fail to get his ducks in a row after all this time? The whole point of the painfully slow roll-out (it became law well over three years ago) was to provide ample time for implementation. How is it that Obama feels he needs to provide big insurers and companies even more time to adapt to changes they've seen coming since 2008, and that they knew about definitively since early 2010?

From the perspective of the little guy, these delays are a disaster. The Mandate is going into effect (the little guy doesn't have a high-priced lobbyist to buy a one year reprieve from the Obama team), but the things that made the Mandate palatable (employer mandates and price controls for some insurers), will be delayed. The opposite pattern could have been explained more easily --delaying the mandate for individuals by a year, while forcing the big companies to comply with the original timeline-- since the big companies have the expertise and resources not to have been taken by surprise by any of this. But insisting on a strict timeline for the little guy while powerful corporations get the rules bent is the kind of thing you see when money is running the show.

Be patient. Rome wasn't built in a day.

 

[Arkady]

Be patient. Rome wasn't built in a day.

I never complained about the original timeline. Three plus years seemed a bit slow for implementing a law that everyone had already known the key terms of for a year before it was even passed. But I figured that exceedingly timid timeline was conservative, in the classic sense of the word, and I could accommodate Obama's conservatism. But, my patience is stretching thin. An already-timid timeline is being delayed even more for the exclusive benefit of big corporations.

Let's compare that to the history of Medicare -- A VASTLY MORE AMBITIOUS REFORM. It was signed into law on July 30, 1965. It was implemented less than a year later on July 1, 1966, with 19 million people enrolling. By the time Medicare was as old as the Affordable Care act already is, new laws had actually expanded it, to cover some younger people (Medicaid). The Social Security system, likewise, was launched in about a year (with the first person who'd reached eligibility retiring five years after it was signed).

I get that Obama was never going to be as bold as LBJ or FDR when it came to domestic policy, but he's not even as bold as George W. Bush. When Bush pushed through Medicare Part B, in December of 2003, he didn't say that those benefits wouldn't start until 2007, much less delaying it, by executive fiat, until 2008. The prescription drug benefit started January 1, 2006, just over two years from signing. Obama "out-conservatives" the arch-conservative. He is a painfully timid politician when it comes to his domestic agenda. That's especially odd compared to his foreign policy agenda, where he is happy to throw our military into battle without so much as a Congressional authorization, much less years of delay.

 

[Barbella]

I was always skeptical of the Affordable Care Act. Put it this way: if you took the forty richest countries in the world and arrayed our healthcare systems from most to least socialized, the US would come out as the very least socialized, with an appreciable margin between itself and the next-closest country... and that's AFTER Obamacare is finally completely phased in. It was a reform built around the goal of preserving corporate profits -- a reform designed by the conservative think tank the Heritage Foundation, and previously championed by Republican standard-bearer Mitt Romney. Yet, despite it essentially being a Republican package that would leave us as an outlier among advanced nations, I supported passage because I thought it was at least a small step in the right direction. Unfortunately, Obama seems intent on making it an even smaller step, or at least a slower one.

First Obama delayed implementation on the rules about businesses providing insurance. Now he's delaying implementation on the rules about maximum levels people can be required to spend:

http://www.salon.com/2013/08/13/another_obamacare_setback/

I get that this is a big, complicated reform, but how did Obama fail to get his ducks in a row after all this time? The whole point of the painfully slow roll-out (it became law well over three years ago) was to provide ample time for implementation. How is it that Obama feels he needs to provide big insurers and companies even more time to adapt to changes they've seen coming since 2008, and that they knew about definitively since early 2010?

From the perspective of the little guy, these delays are a disaster. The Mandate is going into effect (the little guy doesn't have a high-priced lobbyist to buy a one year reprieve from the Obama team), but the things that made the Mandate palatable (employer mandates and price controls for some insurers), will be delayed. The opposite pattern could have been explained more easily --delaying the mandate for individuals by a year, while forcing the big companies to comply with the original timeline-- since the big companies have the expertise and resources not to have been taken by surprise by any of this. But insisting on a strict timeline for the little guy while powerful corporations get the rules bent is the kind of thing you see when money is running the show.

So what else is new? The little guy got screwed again by your Lord and Master.

 

[NightSwimmer]

He's playing politics in order to assure that the Republicans don't regain enough power in Congress to pass a repeal that will actually make it through both houses.

Politics is frustrating to a non-politician, but only politicians can attain high office. Therefore, we'll all just have to hold our noses and watch the politics play out.

Like yourself, I often wish that President Obama actually was the all-powerful Messiah that Republicans like to accuse Democrats of believing that he is. Were that the case, then we would have never had to settle for this crappy compromise to begin with.

 

[ITALIA]

I never complained about the original timeline. Three plus years seemed a bit slow for implementing a law that everyone had already known the key terms of for a year before it was even passed. But I figured that exceedingly timid timeline was conservative, in the classic sense of the word, and I could accommodate Obama's conservatism. But, my patience is stretching thin. An already-timid timeline is being delayed even more for the exclusive benefit of big corporations.

Let's compare that to the history of Medicare -- A VASTLY MORE AMBITIOUS REFORM. It was signed into law on July 30, 1965. It was implemented less than a year later on July 1, 1966, with 19 million people enrolling. By the time Medicare was as old as the Affordable Care act already is, new laws had actually expanded it, to cover some younger people (Medicaid). The Social Security system, likewise, was launched in about a year (with the first person who'd reached eligibility retiring five years after it was signed).

I get that Obama was never going to be as bold as LBJ or FDR when it came to domestic policy, but he's not even as bold as George W. Bush. When Bush pushed through Medicare Part B, in December of 2003, he didn't say that those benefits wouldn't start until 2007, much less delaying it, by executive fiat, until 2008. The prescription drug benefit started January 1, 2006, just over two years from signing. Obama "out-conservatives" the arch-conservative. He is a painfully timid politician when it comes to his domestic agenda. That's especially odd compared to his foreign policy agenda, where he is happy to throw our military into battle without so much as a Congressional authorization, much less years of delay.

I think a lot has to do with the Republican all out effort to undermine the program at the federal and state levels with misinformation and outright lies. So I think these delays may be an effort to blunt all of that. That is Medicare Part D BTW.

 

[Arkady]

He's playing politics in order to assure that the Republicans don't regain enough power in Congress to pass a repeal that will actually make it through both houses.

Politics is frustrating to a non-politician, but only politicians can attain high office. Therefore, we'll all just have to hold our noses and watch the politics play out.

Like yourself, I often wish that President Obama actually was the all-powerful Messiah that Republicans like to accuse Democrats of believing that he is. Were that the case, then we would have never had to settle for this crappy compromise to begin with.

Perhaps. If so, it's beyond conservative, though, since even if the Republicans got a majority in both houses, the chances of them getting a filibuster-proof majority in the Senate, to repeal the bill, is exceedingly remote.

Regardless, even if this is some hyper-conservative effort to hold off repeal, it would be sickening that what he feels he needs to do isn't to make some accommodation for the rank-and-file voter (e.g., delaying the individual mandate for a year), but rather to make two accommodations for big business (delaying the employer mandate and some of the insurance price controls). Maybe that cynicism is justified, and all that really matters is Obama staying in the good graces of the corporate powers that be. but it's pretty damned depressing.

 

[Arkady]

I think a lot has to do with the Republican all out effort to undermine the program at the federal and state levels with misinformation and outright lies. So I think these delays may be an effort to blunt all of that. That is Medicare Part D BTW.

Yeah, I have no idea why I typed "B."

Anyway, maybe the strategy is to, somehow, use the delays to blunt Republican efforts. But, if so, I think it's misguided. It just delays full implementation, giving Republicans more time to campaign against their own fictitious nightmares of what Obamacare is, instead of the simple reality of the eventual program, which isn't anywhere near as scary. Meanwhile, the most unpopular feature of the program, for individual voters, is the individual mandate, and Obama isn't touching that. So, he's leaving Republicans all their best ammunition, while giving them an extra year of cover from which to fire. It's the kind of weak strategic thinking that got us a replay of Romneycare, rather than a more effective program, in the first place.

Also, if EVER there were a time to bite the bullet and take a political hit for the greater good, isn't this it? We're about as far in advance of an election as we get. There won't be a major set of Congressional elections for over a year, and the next presidential election isn't until 2016. Anything that delays the backlash against Obamacare (if there's one even coming) only hurts the Democrats. How does it help to have these issues popping up a year from now, right ahead of a Congressional election, and much farther into the presidential election cycle, rather than to be receding into the rear-view mirror by then?

 

[Corruptbuddha]

I was always skeptical of the Affordable Care Act. Put it this way: if you took the forty richest countries in the world and arrayed our healthcare systems from most to least socialized, the US would come out as the very least socialized, with an appreciable margin between itself and the next-closest country... and that's AFTER Obamacare is finally completely phased in. It was a reform built around the goal of preserving corporate profits -- a reform designed by the conservative think tank the Heritage Foundation, and previously championed by Republican standard-bearer Mitt Romney. Yet, despite it essentially being a Republican package that would leave us as an outlier among advanced nations, I supported passage because I thought it was at least a small step in the right direction. Unfortunately, Obama seems intent on making it an even smaller step, or at least a slower one.

First Obama delayed implementation on the rules about businesses providing insurance. Now he's delaying implementation on the rules about maximum levels people can be required to spend:

http://www.salon.com/2013/08/13/another_obamacare_setback/

I get that this is a big, complicated reform, but how did Obama fail to get his ducks in a row after all this time? The whole point of the painfully slow roll-out (it became law well over three years ago) was to provide ample time for implementation. How is it that Obama feels he needs to provide big insurers and companies even more time to adapt to changes they've seen coming since 2008, and that they knew about definitively since early 2010?

From the perspective of the little guy, these delays are a disaster. The Mandate is going into effect (the little guy doesn't have a high-priced lobbyist to buy a one year reprieve from the Obama team), but the things that made the Mandate palatable (employer mandates and price controls for some insurers), will be delayed. The opposite pattern could have been explained more easily --delaying the mandate for individuals by a year, while forcing the big companies to comply with the original timeline-- since the big companies have the expertise and resources not to have been taken by surprise by any of this. But insisting on a strict timeline for the little guy while powerful corporations get the rules bent is the kind of thing you see when money is running the show.

It's a massive clusterfuck. It has always been a master clusterfuck. It will always be a massive clusterfuck.

All because it was designed to fail.

And as to why Nerobama didn't see it coming...that's easy...he knows as much about insurance and healthcare as you and I know about Circadian Rhythm Biology.

 

[connieb]

I was always skeptical of the Affordable Care Act. Put it this way: if you took the forty richest countries in the world and arrayed our healthcare systems from most to least socialized, the US would come out as the very least socialized, with an appreciable margin between itself and the next-closest country... and that's AFTER Obamacare is finally completely phased in. It was a reform built around the goal of preserving corporate profits -- a reform designed by the conservative think tank the Heritage Foundation, and previously championed by Republican standard-bearer Mitt Romney. Yet, despite it essentially being a Republican package that would leave us as an outlier among advanced nations, I supported passage because I thought it was at least a small step in the right direction. Unfortunately, Obama seems intent on making it an even smaller step, or at least a slower one.

First Obama delayed implementation on the rules about businesses providing insurance. Now he's delaying implementation on the rules about maximum levels people can be required to spend:

http://www.salon.com/2013/08/13/another_obamacare_setback/

I get that this is a big, complicated reform, but how did Obama fail to get his ducks in a row after all this time? The whole point of the painfully slow roll-out (it became law well over three years ago) was to provide ample time for implementation. How is it that Obama feels he needs to provide big insurers and companies even more time to adapt to changes they've seen coming since 2008, and that they knew about definitively since early 2010?

From the perspective of the little guy, these delays are a disaster. The Mandate is going into effect (the little guy doesn't have a high-priced lobbyist to buy a one year reprieve from the Obama team), but the things that made the Mandate palatable (employer mandates and price controls for some insurers), will be delayed. The opposite pattern could have been explained more easily --delaying the mandate for individuals by a year, while forcing the big companies to comply with the original timeline-- since the big companies have the expertise and resources not to have been taken by surprise by any of this. But insisting on a strict timeline for the little guy while powerful corporations get the rules bent is the kind of thing you see when money is running the show.

As NS pointed out, this is about the upcoming election.

Small Businesses ( and yes there are thousands and thousands of businesses who qualify as "small" but have more than 50 employees) are really struggling implementing this. Additionally.... more and more companies are deciding that reducing working hours to get non-essential employees under 30 hours or laying off employees to get under the 50 magic number is looking like a much better plan.

So, what happens to the democrats in next year's election if the majority of low and middle income wage earners have just been layed off or had their working hours decreased in response to the company preparing for Obamacare? Wouldn't look too good for them, I don't think. And, you think every employer who is considering that move isn't blaming it on Obamacare?

While it in some cases is clearly a case of employers wanting to screw their employees, I have seen many clients struggle with this who don't want to screw their employees but at the same time really just can not absorb the additional cost. While they may have offered insurance, they can not afford to cover the additional amount to get it "affordable" to the lowest paid employee. Maybe they already paid half, but that half is $250 per employee. If that $250 is still not "affordable" for the lowest paid full time employee - but $100 is - then they may have to pay an additional $150 for each employee. That could amount to tens of thousands or hundreds of thousands of dollars a year. And, while yes, there are exclusions and employees can opt to exchanges, etc - a business owner has to plan based on the degree of risk... and right now the risk really looks like in many cases not only will employers have to expand the pool of employees they are paying benefits for, they will have to pay a bigger percentage of those benefits. Most of my clients simply can't afford to add that kind of cost to their bottom line and they are trying to figure out ways to not have to do that. But, in the mean time, putting the mandate off a year - certainly saves those jobs and work hours for about another year.

It will be interesting to see if its enough though to keep the sheep happy or if they will figure out that the democrats just kicked the can down the road and this time next year their job will be right back on the chopping block.

 

[Mytzlplk]

that's what happens when you try to avoid or want to make a step towards the inevitable. http://www.forbes.com/sites/theapot...solutely-a-step-toward-a-single-payer-system/

http://crooksandliars.com/susie-madrak/study-medicare-all-would-save-half-tr

This is why I've never understood the rightwingnut whining on the matter. They should be hoping for and working on its success, as opposed to trying to pull the bandaid off.

 

[NightSwimmer]

Perhaps. If so, it's beyond conservative, though, since even if the Republicans got a majority in both houses, the chances of them getting a filibuster-proof majority in the Senate, to repeal the bill, is exceedingly remote.

Regardless, even if this is some hyper-conservative effort to hold off repeal, it would be sickening that what he feels he needs to do isn't to make some accommodation for the rank-and-file voter (e.g., delaying the individual mandate for a year), but rather to make two accommodations for big business (delaying the employer mandate and some of the insurance price controls). Maybe that cynicism is justified, and all that really matters is Obama staying in the good graces of the corporate powers that be. but it's pretty damned depressing.

Follow the money. You may well have better political judgment than does President Obama, but you didn't get elected to two terms as POTUS, so I'm reserving judgment on that one.

 

[barbarap]

The ACA is being implemented in phases similar to most legislation this size.

The first phase has been implemented for a year now and has benefitted many individuals.

The second phase is set to roll out jan 1, 2014 with open enrollment (in California, at least) beginning in October.

Legislation this big takes years of work and amendments.

 

[Arkady]

It's a massive clusterfuck. It has always been a master clusterfuck. It will always be a massive clusterfuck.

All because it was designed to fail.

And as to why Nerobama didn't see it coming...that's easy...he knows as much about insurance and healthcare as you and I know about Circadian Rhythm Biology.

Actually, I'm an endocrinologist who has spent the last ten years studying the pineal gland and the impact of serotonin and melotonin on daily organ cycles.

 

[NightSwimmer]

It will be interesting to see if its enough though to keep the sheep happy or if they will figure out that the democrats just kicked the can down the road and this time next year their job will be right back on the chopping block.

You are young and naïve. This isn't about pacifying sheep. It is about controlling the flow of campaign funds in the upcoming midterm elections.

 

[Corruptbuddha]

Actually, I'm an endocrinologist who has spent the last ten years studying the pineal gland and the impact of serotonin and melotonin on daily organ cycles.

And I'm the Queen of England!

Such a pleasure to make your acquaintance.

 

[Arkady]

Follow the money. You may well have better political judgment than does President Obama, but you didn't get elected to two terms as POTUS, so I'm reserving judgment on that one.

It's about goals. My goal is to improve the lives of Americans. Obama's goal was to secure himself a job for eight years. I have nothing but admiration in his political acumen when it comes to accomplishing that second goal, but the first one is what concerns me.

 

[Arkady]

The ACA is being implemented in phases similar to most legislation this size.

The first phase has been implemented for a year now and has benefitted many individuals.

The second phase is set to roll out jan 1, 2014 with open enrollment (in California, at least) beginning in October.

Legislation this big takes years of work and amendments.

It took less than a year to roll out Medicare, which is far more ambitious -- being a single-payer socialized system.

 

[Arkady]

And I'm the Queen of England!

Such a pleasure to make your acquaintance.

I had my suspicions that was you, Liz.

 

[connieb]

You are young and naïve. This isn't about pacifying sheep. It is about controlling the flow of campaign funds in the upcoming midterm elections.

Well, I would also think its about getting voters. Voters who may not be really happy to have their hours cut and or be laid off. But, you are probably right, right now its about campaign funds. Screw the individuals who will be left with a smaller paycheck next year.