RANCHO SANTA FE, Calif., March 24, 2014 — As we approach the first enrollment deadline of the Affordable Care Act on March 31 of this year, we should ask some questions: Is the Administration committed to the ACA’s success for political reasons or because of a passionate belief in the virtue of the Act? Is the President more interested in preserving his legacy or providing better health care to the masses?
Yesterday, March 23, marked the fourth anniversary of the Patient Protection and Affordable Care Act — Obamacare. Four years on, the debate rages as to whether patients will be protected and whether health care will become more affordable.
In its inception, the ACA’s mission was to expand access to health care to 50-plus million people — the number of uninsured Americans — while simultaneously lowering the cost of health care and maintaining or improving its quality. As is often the case when political interests collide, many aspects of the mission are lost in the legislative execution.
An underwhelming number of those who previously lacked access to health care insurance seems to have capitalized on the opportunity that the ACA ostensibly provides. The Obama Administration hopes that 6 million will have enrolled by the end of the month. In many regards, costs have risen, at least with regard to non-subsidized insurance coverage, and the quality of coverage, while expanded, may not reflect need; in the interest of equality, differences in gender, age, etc. have been intentionally ignored.
It is also worth noting that insurance coverage has become the focus of the ACA as opposed to the actual delivery of health care, as if the two were synonymous, which they are not.
So, let’s examine the infectious political disease that has contaminated the program to determine whether the situation is terminal.
During the 2008 campaign, then-Senator Barack Obama spoke eloquently about his plan to deliver health care reform. In conformance with his commitment to creating a more transparent and bipartisan Government, he promised to have the health care debate televised and to have the proposed legislation available for public review no less than 72 hours before any vote would be taken.
Had his promises been fulfilled, we may have avoided the bitter gamesmanship and comedy of errors that have plagued the ACA throughout the legislative process and since its passage. Unfortunately, those promises rose only to the level of other campaign promises that are spoken for effect rather than with any intent to deliver upon them.
Republican members of Congress were quick to condemn health care reform even before there was any substance to analyze. They assured us that whatever form it took would bankrupt our country and lead us down the road to socialistic failure.
Their commitment to assuring its failure has remained steady. They have proposed repeals at a rate only rivaled by the growth rate of our national debt.
Never one to allow a divisive political opportunity to go to waste, the Democratic Party seized the opportunity to demonize Republican opposition and leverage its control of the House, Senate, and Administration to cram through a bill filled with pork and favors to supportive lobbies.
The concept of debate surrendered to brute force politics and threats of nuclear options; the concept of providing television coverage gave way to closed-door caucuses; and the term “bipartisan” was transformed into something more akin to “buy partisan” when it came time to secure the necessary votes through backroom deals.
As a result, our nation finally had significant healthcare reform, the administration could claim victory, and the president had a landmark piece of legislation to define his legacy.
More political promises began to flow. “If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”
Despite a stagnant U.S. economy, the administration entered into a $94 million contract with a Canadian firm in October 2011 to develop the Healthcare.gov website. Two years and something north of $300 million later, the president promised that the website would be ready to go on October 1 and that millions of Americans would be able to begin to enroll.
Then, the real world intervened.
While the website launched on time, it couldn’t handle even the modest initial web traffic it attracted. It crashed and burned.
It was later revealed that the administration had been given “stark warnings” of the impending debacle a full month before it occurred. However, there was an ongoing political battle over the budget and debt ceiling, so the warnings were ignored, and the website was used as a political subterfuge to draw attention to the recalcitrant Republicans, who were being characterized as “terrorists” at the time.
Since then, the Healthcare.gov website has suffered a variety of “illnesses” including ongoing volume-handling issues; an inability to process enrollments automatically; security risks with respect to confidential information; a mistranslation of the website for non-English-speaking Americans; and most recently, the incorporation of the wrong year’s poverty statistics that provide the basis upon which subsidies are calculated. In the interim, quickly trained “assistants” were exposed for aiding and abetting the commission of fraud during the enrollment process to help enrollees secure better rates.
Meanwhile, conservative groups have run questionable ads, and House Republicans have monotonously tried to repeal the legislation with no hope of securing a favorable vote in the Senate or having any chance of securing the president’s signature in the unlikely event Majority Leader Reid allows anything to make it through Senate.
Why do Republicans continue to pursue this futile course?
When you don’t have a solution of your own to offer, sometimes it’s politically expedient to attack the opposing Party on an issue from which it will have difficulty hiding.
Clearly, with regard to the ACA, the Democratic Party has little cover. Not a single Republican voted for the bill, and the 34 Democrats in the House who crossed party lines to vote with the Republicans have all but been buried by the Party. Beyond that, no one can legitimately argue that the program has been rolled out intelligently or that it has been a resounding success.
So, what can the Democrats do?
Engage in a game of pretend: Try to distract the public’s attention with other issues; use marketing gimmicks to make the program appear to be functioning; and, find a way to exploit its vulnerability to raise money and support.
The Democratic Party is gifted in this regard. It has historically been successful at sleight-of-hand politics. Otherwise, its blatant failure to advance causes on behalf of minorities and the poor when it has had control of the Legislative and Executive branches of the Government (other than in the most superficial ways), is legendary.
Even the web-based structuring of the ACA’s delivery system serves as an example. If the Democratic Party believes voter identification initiatives are designed “to repress the minority vote” and are “disproportionately burdensome” for the poor, how does it expect these same individuals to have Internet access and computers to be able to enroll through Healthcare.gov? Is the ACA just another racist program? (Just kidding.)
Perhaps what the Party really needs is a videotape upon which to blame the spontaneous failure of the Healthcare.gov website.
As for marketing gimmicks: When was the last time you saw tens of millions of your tax dollars spent on advertising to convince the general public (or a few core demographics within it) that everyone should do the “happy dance” about a Government program? Shouldn’t the legislation speak for itself? Do we really need ads to convince us to enroll (particularly ones that inexplicably incorporate offensive stereotypes without any apparent blowback)?
Then, there is the endless stream of Party e-mails asking for $3 to $5 dollars or for volunteer efforts to make calls to convince people to enroll in “Obamacare.” We are expected to believe that many of these are personally sent to us by the president, his wife, and Vice President Biden. Are we really that stupid? (The question is rhetorical.)
So, when the initial numbers are released after the first enrollment period closes on March 31, what should we expect?
Primarily, expect to be misled. The numbers will neither be as poor as the Republicans will lead you to believe nor will they approach the fantasy-level of performance the Democrats will attach to them.
Then, demand that the numbers be broken down demographically. This is extremely important to understanding the level to which the program is performing.
Age distribution is critical. Any acceleration of Medicare enrollment merely drives our Nation deeper into debt, and keep in mind, unfunded liabilities like Medicare are not reflected in the $17 trillion debt that strikes fear in most American’s hearts.
Correspondingly, someone has to pay more into the system than others extract. Are you listening, Millennials? That would mean you! Healthcare requirements increase with age. If a disproportionate percentage of enrollees are older, healthcare costs will rise rather than fall. It’s called “math.”
Next, look at the racial and economic demographics. Are the categories of individuals you were told would derive a benefit from the ACA actually deriving a benefit from the ACA or is this just another example of bait-and-switch politics?
Finally, determine the voluntary versus involuntary level of paid enrollments. Some States are requiring prisoners to enroll in the ACA (or Medicare). Other individuals, who already had health insurance, lost their insurance because of the ACA and have been forced to enroll in the ACA or face the prospect of a fine and no coverage.
Coerced enrollments do not constitute voluntary enrollments and should not be counted toward the “success” of the program.
Political disease has weakened the affordable health care initiative, and the concept is staggering around and potentially infecting the rest of the economy. While many of the symptoms are obvious, the antidote cannot be discovered without a truthful examination of the facts.
Will the Parties put their selfish partisan bickering aside to allow us to ascertain the truth when it comes to the ACA? Will the President, who wrote his first autobiography before the age of 34 and his second just after turning 45, put his ego aside and provide a glimpse of the bipartisan leadership he promised so we can begin to heal the wounds inflicted by his landmark legislation? Only time will tell.
In the interim, here’s to your health!
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T.J. O’Hara is an internationally recognized author, speaker, and strategic consultant in the private and public sectors. In 2012, he emerged as the leading independent candidate for the Office of President of the United States and the first nominee of the Whig Party in over 150 years.
This article first appeared in T.J. O’Hara’s recurring column, A Civil Assessment, in the Communities Digital News (CDN).