A Hard Sell

Members of Congress are returning to Washington wondering what happened to President Obama’s promise that he could convince a very skeptical public that his health-overhaul plan is a good thing after all.

Many members who voted for the legislation had to hide out from their constituents over the Easter recess to avoid scathing criticism. Public animosity toward Obamacare is getting worse, not better, with Rasmussen showing that 58 percent now want it repealed. Fox reported last week that only 12 percent want the legislation to be implemented as is.

People are not buying into the president’s sugarcoating because they can see for themselves the destructive path ahead. Every day more facts emerge about the legislation Congress slammed through on a hyper-partisan vote:

1. Doctor shortages loom: Experts warn there won’t be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the U.S. faces a shortage of up to 150,000 physicians in the next 15 years, according to a report by the Association of American Medical Colleges.

2. Costs continue to soar: Massachusetts governor Deval Patrick is in a knock-down, drag-out battle with health insurers. He is refusing to allow them to raise their rates to cover the added costs they are incurring as a result of the state’s three-year-old universal coverage law. The companies lost a first-round court battle yesterday. They say they will lose hundreds of millions of dollars and could go out of business if they can’t raise their rates to at least cover their costs.

Sen. Dianne Feinstein (D., Calif.) is reportedly shocked that the new law does not give federal regulators the power to block double-digit health-insurance-premium increases. In a preview of battles to come, Sen. Feinstein and Rep. Jan Schakowsky (D., Ill.) are pushing legislation to expand federal and state authority to prevent insurance companies from boosting rates excessively. This is a direct path to a single-payer, government-run health system.

3. Where’s my free health care? eHealthInsurance, the online broker for health insurance, says it has been flooded with calls from people asking, “Where do we get the free Obamacare, and how do I sign up for that?” Would-be customers had expected the overhaul law to translate into instant, affordable coverage.

Are people happy when they find out that the subsidized coverage doesn’t begin for four years and that even then, only a fraction of people will qualify? What about when they learn that most Americans will be required to buy expensive, government-mandated policies? Or that new taxes start right away but still won’t make a dent in the tsunami of red ink the law creates?

4. Five little words: States and physicians have a new concern: Tucked away in the 2,700-page health overhaul law are five words that states fear will open the floodgates for lawsuits.

Until now, states participating in Medicaid have been required to provide payments to physicians. But on page 466 of the new law, states now will be liable for ensuring provision of “the care and services themselves.”

That means states are legally required not only to ensure that services are paid for, but that Medicaid recipients are seen by a doctor. Alan Levine, Louisiana’s health secretary, says this “leaves every state vulnerable to a new wave of lawsuits any time someone cannot access a service.” He says the added cost would be incalculable.

5. Ninety days to get going: The clock is ticking on the 90 days that HHS Secretary Sebelius has to get programs established in the states to provide coverage for uninsured people with high health risks. It is the tip of the iceberg in a mountain of regulations that must be written to get Obamacare up and running.

Demonstrating growing state rebellion against Obamacare, Georgia announced yesterday it isn’t going to participate in the new high-risk pools.

6. Constitutional challenges continue: Virginia attorney general Ken Cuccinelli argues that there is no constitutional authority for Congress to regulate commerce when citizens just want to do nothing — for instance, not buy insurance. He also argues that Medicare and Social Security are based upon constitutional taxing authority. But he says that a mandate to buy private insurance is not a tax; the tax is a penalty for not buying a product from a private company — an unprecedented demand from the federal government.

And finally, Cuccinelli says the legislation did not include a “severability” clause, which means that if one provision is declared unconstitutional, the whole law can be thrown out.

Officials are facing the growing realization that the legislation is very poorly drafted. The Senate bill never was intended to go into law as is; leaders believed they would be able to merge the House and Senate measures into a cleaned-up and final version of the bill. It was primarily a vehicle to cobble together 60 votes in the pre–Scott Brown Senate.

But after Democrats lost their filibuster-proof majority, the only choice was to pass the dreaded Senate bill as is. Now they have a poorly-drafted bill that exacerbates already overwhelming implementation challenges.

In a bit of justice, it turns out that the law creates significant confusion about whether or not members of Congress actually still have health insurance. The bill was amended in the Senate to make sure members and staff are in the system they created for the rest of us and must get their insurance through the new exchanges. But now there is confusion about whether or not they have coverage until the new exchanges actually start in 2014. A 13-page, single-spaced memo from the Congressional Research Service reaches no conclusion.

Over the coming months and years, those who voted for health overhaul will find themselves perpetually on the defense in explaining the cascade of problems it creates, and opponents surely will not hesitate to point out its failings and who is responsible.

The uninsured rolls will continue to swell, the huge tax increases will kill jobs and depress economic growth, seniors will start facing the consequences of Medicare Advantage cuts, deficits will continue to soar, and the quality of care will steadily get worse as doctors and hospitals become more responsive to bureaucrats than to patients. Obamacare will be blamed.

Published in National Review Online: Critical Condition, April 13, 2010.

Posted in: Uncategorized