This is the Bonus segment in my series on how the Affordable Care Act impacts all of us.
In the course of researching this series, I came across a number of additional subjects that I would like to pass along, so I have added this Bonus posting. In this Bonus, I will cover subjects such as what was left out or struck out of the Obamacare Bill, whose idea was Obamacare in the first place and who wrote it, what is the ultimate goal of Obamacare, and what’s being done to implement it.
What Was Left Out of the Affordable Care Act?
• Tort Reform. If one of the main goals of Obamacare is to reduce the cost of health care, one would think that Tort Reform would have been a part of it. Civil suits and their attendant multimillion dollar awards against doctors have forced health care costs to increase significantly. First, the cost of malpractice insurance has become prohibitively expensive. Second, in an effort to avoid tort action, doctors have ordered redundant and unnecessary tests and performed defensive procedures. Such protective practices increase the costs of care, in some cases substantially. One would have thought that Tort Reform would have been included in the Bill. Until, that is, we acknowledge that health care tort awards support a good segment of the trial lawyers’ incomes. Is it too cynical to note that trial lawyers contribute heavily to the Democratic Party?
• The Public Option. “The Public Option” has come to be thought of as a government takeover of the health insurance industry. It is not, at least in so far as the Affordable Care Act is concerned. “The Public Option” in the latter sense was the establishment of a government insurance operation that would compete with private insurers. Opponents objected that, through subsidies and price fixing, a government insurance operation would put the private insurers out of business and that government-run insurance operations and premiums would then bloat beyond what the private insurers could have provided. As such, “The Public Option” was seen as an indirect takeover. Unable to overcome these fears, Congressional Democrats took it out of the Bill.
• State Low Cost Options. Many know that some years ago Massachusetts adopted a health insurance law similar to Obamacare. A much more modest plan exists in the State of Utah. A number of States lobbied to be free to set up their own plans in an effort to learn what approach works best for them. They were denied. Instead, Obamacare centralizes comparative effectiveness research in a new agency – the Patient Centered Outcomes Research Institute. This Institute will be able to conduct its own studies and to fund and oversee studies in higher education and in non-academic research settings.
• Exemptions. A number of exemptions to Obamacare penalties have already been cited in the form of waivers, most notably to unions and select corporations. Many more were written right into the Law, including:
Sufferers of financial hardship (defined as cost of insurance to them as being over eight percent of their income).
The very poor (defined as having income below the tax filing minimum).
Those who are uninsured for a brief time (defined as three months or less).
Persons having religious objections.
Members of Congress and their staffs (see below).
The President and his family.
Whose Idea Was This Anyway?
The Administration won’t say whose idea this was nor who wrote the Bill. This shouldn’t be a surprise to those who recall that Congressional Democrats wouldn’t even allow the Bill to be read until after it was passed. There are three likely sources of the Bill:
1. Jacob S. Hacker for George Soros’ Economic Policy Institute. Hacker is a Yale professor who in 2001 delivered a report titled “Health Care for America” to Soros’ Agenda for Shared Prosperity. This report is said to be the blueprint for Obamacare. Then, in 2003, Hacker produced a new plan that was proposed to be the National Healthcare Insurance Act of 2005.
2. Jonathan Gruber for Massachusetts. Gruber is an MIT professor of economics who conceived and drafted the legislation for the Massachusetts law. Under contract with the U.S. Health and Human Services Department, Gruber also conducted the economic analysis of the Obamacare Bill.
3. Liz Fowles for Senator Max Baucus, (D) Montana. Fowles is said to be the author of the actual Obamacare legislation. Baucus is the Chairman of the Senate Finance Committee from which the Bill came. Fowles was Chief Counsel to the Committee from 2001 to 2005. Then, she was Vice President for Public Policy at Wellpoint, one of the nation’s largest private health insurers. In 2008, she went back to Baucus’ staff. In November, 2008, she delivered to the Committee an 87 page whitepaper which is said to have been the blueprint for the actual Bill. Thereafter, she supervised the Bill writing team. She is now said to be working directly for President Obama, although a return to the private sector again may be in the offing.
Implementation of Obamacare.
Implementation efforts have been underway to one degree or another in the Administration as well as in the States. Although very little of the mechanics have been made known, these are some key observations:
• New Government Agency. $400 million has been allocated for the creation of the new government agency to implement Obamacare – the Centers for Medicare and Medicaid Services. Among many other duties, the Centers will operate call centers and outreach services to inform the public of their rights and requirements. The Centers will also process applications for state exchanges.
• Selling Obamacare. The Department of Health and Human Services has hired the advertising agency of Weber Shandwick to promote the law and the exchanges. The original contract of $20 million has been expended and an additional $11 million has now been granted. In addition, George Soros is reported as has given $5 million for advertising.
• “Navigators.” Due to the complexity of Obamacare and the unlikelihood that the public will understand it, the State of California has announced that it will hire and train some 21,000 “navigators.” These will be outreach workers who will counsel the public and usher them through the process. It is likely that at least some other states will be required to do the same kind of thing.
• Set Up of the Exchanges. The state of progress in setting up exchanges is in flux. Not all states have made a final decision as to whether or not they will operate their own exchanges or turn this over to the federal government. Few states have made significant announcements beyond the participation/nonparticipation level. The U.S. Department of Health and Human Services has been preparing to take over the set up of state exchanges since 2010, but can do little until each State makes its official announcement. Since the factors affecting each State’s needs vary significantly, it is expected that extreme confusion is likely in the early implementation period.
Goals of Obamacare. The stated goals of Obamacare have been:
• Assure that as many of the estimated 31 million uninsured people as possible become insured.
• Add benefits and protections to those already insured and the newly insured.
• Reduce the costs of medical care.
• Reduce the costs of Medicare and Medicaid.
• Reduce the costs of insurance premiums.
I leave it to the reader to deduce what the unstated goals may be and to assess whether the goals are met and whether it will have been worth the trip.
Current Events. These are some of the latest developments in the Obamacare story, as of this writing:
• Estimated costs of Obamacare to the average family are going up. Instead of going down, as advocates of Obamacare predicted, the Congressional Budget Office’s estimate in 2012 was $2,000 more per year than they are now paying. On April 30, 2013, Elizabeth Colbert, Democratic Representative from South Carolina estimated the cost now to be $4,000 per year more than they are now paying.
• Congress is in the process of or has already passed an exemption from Obamacare for itself, their staffs and the President and his family (see above).
• Congress has granted health insurance companies an anti-trust exemption (citation needed).
• The first rollout of Obamacare application forms brought howls of complaint – it’s length rivaled the tax forms and it was too complex to understand. This week a revised version was released. It was down to five pages, minimum, for single people and 24 pages for families. It still requires the reporting of all family finances, so applicants will be urged to gather past years’ income tax returns, pay stubs and family financial records before starting to fill it out.
• Senator Max Baucus, the purported supervising author of Obamacare, abruptly announced his retirement from the Senate last week, citing Obamacare as a “train wreck.” President Obama replied, “All major legislation is a train wreck when first implemented.” Cynics expect to see Baucus turn up in the Public Policy department of one health insurance company or another or as a lobbyist for the health insurance industry.
This ends my series on Obamacare. This is as simple as I can make it. The law has been reduced to 907 pages (from the 2,700 page Bill) while the regulations have grown to 15,000 pages, so far. There are other provisions that will come to light as the law is understood, interpreted, massaged by regulations, and, perhaps, amended. This entire area of public policy is likely to change, perhaps dramatically, as more people begin to find out what is in it, so attention to the news from Washington is strongly advised. Be an informed citizen.