Week In Review: Politics Of Health Reform Implementation, Insurance Mandate, More CBO Estimates
This week, the Obama administration continued planning how to turn the health law into policy and practices.
On Monday,Ìýthe White House issued rules related to the new law’s provision paving the way forÌýyoung adults to stay on their parents’ health insurance untilÌýage 26. Ìýreported that “the promise of this coverage has attracted great interest” as employers and insurance companies have been flooded with inquiries. AndÌý“Kathleen Sebelius, the secretary of health and human services, estimated that 1.2 million people would gain coverage because of the new requirement”Ìý(Pear, 5/10).Ìý
(KHN’s Morning Edition onÌýMay 10Ìý²¹²Ô»å May 11Ìýfeatured details on the young adult rules.)
The unveiling of the guidelinesÌýwas one of the ways the administration seemed to be staking a claim in the increasingly intenseÌýpublic opinion tug-of-war.ÌýSebelius sent aÌýÌýto congressional leaders citing the progress onÌýsuch “early insurance market reforms.” Ìýdescribed itÌýas part of an effort “to convey the impression that the debate is over and the health care train is leaving the station. … [It]Ìýwas sent to House Speaker Nancy Pelosi, Minority Leader John Boehner, Senate Majority Leader Harry Reid and Minority Leader Mitch McConnell, as well as leaders of the health-related committees” (Haberkorn, 5/10).
Meanwhile,Ìýthe White HouseÌýwas exploringÌýhowÌýto help congressional DemocratsÌýuseÌýthe health overhaul to win support during the midterm election season.ÌýÌýreported that lawmakers met Tuesday evening with White House officials “to discuss the latest steps the administration has been taking to put in place the early deliverables of health reform.” And someÌýmembers sought a specificÌýcommitment thatÌýPresident Barack Obama would continueÌýhelping to sell the bill” (Pecquet, 5/11).
Voter anxietyÌýcould be a hitch inÌýthis plan, according to :Ìý“polls show voters aren’t totally on board withÌý[Obama’s] achievements, at least not yet, and the White House acknowledges that his victories have carried huge financial and political costs” (Page and Hall, 5/12).
Congressional Republicans have their ownÌýpublic relations strategy.ÌýÌýreported thatÌýunder “the slogan ‘second opinion,’ Republicans plan to communicate their message on multiple fronts, including on the Senate floor, in press conferences, via the Internet and through television and radio appearances.”ÌýAnd the GOP has already begun criticizingÌýDonald Berwick,ÌýObama’s pickÌýto run the Centers for Medicare and Medicaid (Drucker, 5/13).ÌýÌý reportedÌýthat Senate Minority Leader Mitch McConnellÌýon Wednesday calledÌýBerwickÌýan “expert on rationing” and aÌýSenate Republican Policy Committee paper said he would steerÌýthe agencyÌýtoward a “brave new health care world” (Milligan, 5/13).
(The May 11, May 12Ìý²¹²Ô»å May 13 Daily Health Policy Reports includeÌýmore coverageÌýof theseÌýdevelopments.)
This week also wasÌýmarked by legal challenges to the healthÌýlaw’s requirement that individuals buy insurance.Ìý“Efforts to block a key provision of the new health-care overhaul law are underway in 33 states, as a growing roster of mostly Republican officials have mounted legal and legislative challenges to an eventual requirement that virtually all Americans buy health insurance or pay a penalty tax,” according to Ìý(Aizenman, 5/12).
ÌýÌýdetailed one of theseÌýcases,Ìýwhich was initially brought by Florida. “Some legal scholars, including some who normally lean to the left, believe the states have identified the law’s weak spot and devised a credible theory for eviscerating it. The power of their argument lies in questioning whether Congress can regulate inactivity – in this case by levying a tax penalty on those who do not obtain health insurance.” But The Times also points out that the legislation’s draftersÌýwere careful to protect the lawÌýfrom this type ofÌýconstitutional challenge. The central issue, according to the report,Ìýrelates toÌýthe Supreme Court’s interpretation of the Commerce Clause. If the court takes a broad view,Ìý“the health insurance mandate is likely to survive” (Sack, 5/10).
AndÌýtoday, the National Federation of Independent BusinessÌýannounced its intent toÌýsign onto theÌýFlorida lawsuit.Ìý notedÌýthat the involvement of thisÌýsmall business lobbyÌýall but guarantees that the constitutional issues — regardless of how they are received in courtrooms —Ìýwill beÌýplayed out inÌýupcoming congressionalÌýcampaignsÌý(Alonso-Zaldivar, 5/14).
Ìýreports that theÌýJustice Department this week released anÌýofficial response to a suit, brought byÌý“a conservative public interest group,Ìýthe Thomas More Law Center,”Ìýto block the law from taking effect. The groupÌýcharged thatÌýthe mandateÌý“was beyond the scope of Congress’ power and was an unconstitutional tax.”ÌýThe Justice Department reply noted that “Congress acted to address a national problem, the minimum coverage provisions were constitutional and the lawsuit was premature because no one had been harmed by the law” (Pelofski, 5/12).
(For more news coverage, see the May 11Ìý²¹²Ô»å May 13ÌýMorning Edition.)
Finally, a new round of Congressional Budget Office cost estimatesÌýreleased this week muddied theÌýdebate surrounding the healthÌýlaw’sÌýactual price tag. ÌýÌýreported on Tuesday that, based on the newÌýprojections, the measure “could potentially add at least $115 billion more to government health care spending over the next 10 years.” The estimates includedÌý“$10 billion to $20 billion in administrative costs to federal agencies carrying out the law, as well as $34 billion for community health centers and $39 billion for Indian health care” (Alonso-Zaldivar, 5/11).
Almost immediately,Ìýbackers and detractorsÌýsprang into action. “Republicans pounced on the news, which they called another sign that the Obama administration makes promises it cannot deliver,” according to Ìý(Haberkorn, 5/11). But the White House offered strong statements of its own, saying, as reported byÌý,Ìýthat the health overhaul “will reduce the deficit by more than $100 billion in the first decade, and that will not change unless Congress acts to change it. The President has called for a non-security discretionary spending freeze, and he will enforce that with his veto pen” (Pecquet, 5/11).ÌýAnd, as the back-and-forthÌýbecame increasingly heated, complicated and even weedy, and Ìýtook toÌýtheirÌýblogsÌýin an attempt toÌýflesh out further, from each of their own perspectives, what the spending projections meant.
