White House is quietly implementing a shrewd new strategy of silence on
Obamacare. Its goal: making sure the revolt against the unpopular
health care overhaul that swept Republicans into power across the
country in November 2010 isn’t repeated in 2012.
After two years
of nonstop focus on health care, the president has stopped talking about
the law’s far-reaching effects. Now he is concentrating on a few micro
changes. Meanwhile the administration is working hard to dampen
controversy by handing out buckets of waivers and attacking Republicans
Bringing Obama around to this new course wasn’t
easy for his advisors. The day after last November’s elections, the
president belligerently refused to acknowledge that the results were a
referendum on his unpopular policies or that Obamacare had hurt
Democratic candidates. His health policy agenda was correct and possibly
only needed a bit of “tweaking,” he insisted.
But his advisers
pored over the election results and reached an inescapable conclusion.
“The economy, as important as it was, was not the decisive factor this
election. Health care was,” Democratic pollster Pat Caddell said just
after the election. “It is?health care [that] killed them,” Caddell said
of the 63 defeated House Democrats. “The American people found this a
crime against democracy?they want it repealed, and this issue is gonna
go on and on.” Now the White House’s strategy has the president talking
as little as possible about Obamacare.
We haven’t intercepted
their memo to the Oval Office, but we can extrapolate from recent White
House tactics what his advisers have recommended Obama must do:
1. Stop talking about it.
Every time you talk about the sweeping overhaul of health care, your
poll numbers go down. People know you can’t spend $1 trillion and
pretend to reduce the deficit. Or take more than $575 billion out of
Medicare and make it stronger. Anyway, it is now the law of the land and
the wheels of bureaucracy are grinding to make sure it takes effect in
2014. Your only job right now is to get reelected to veto any reform
bills passed by the next Congress.
2. Focus on the small stuff.
People don’t know what is in this law, as Republicans so annoyingly
continue to remind us with Nancy Pelosi’s unfortunate quote — “We have
to pass the bill so you can find out what’s in it.” We can calm the
opposition if the public is convinced that it’s only about putting
26-year-olds on their parents’ health insurance, free preventive care,
risk pools for preexisting conditions, and some new insurance
regulations. We should call attention to those who have already
benefited from the law’s early provisions. If people believe it is only
about small changes, they will wonder what all the fuss was about.
3. Attack Republicans.
Health care is a Democratic issue and always will be. So go after
Republicans for their ridiculous ideas about “private competition” and
“putting consumers in charge of decisions.” Paul Ryan has given you a
golden opportunity to target Republicans for trying to destroy Medicare
and forcing seniors to pay thousands of dollars more for health care.
Hammer away at him.
4. Calm the opposition. The most
important thing is to keep opponents quiet. Health Secretary Kathleen
Sebelius is a key ally here since the health law gives her so much power
over how it is implemented. Focus on the governors. Sebelius should
find ways to give them temporary relief from Medicaid costs. She also
should issue waivers to states, companies, and anyone else who complains
the new law is hurting them.
THE NEW OBAMACARE strategy is
working smoothly except for tactic number 4. The waiver tactic
backfired, as it became clear that waivers from the law’s early
provisions were needed and were being granted disproportionately to
politically favored groups (restaurants and spas in San Francisco and
hundreds of labor unions, for example). To calm the negative press, the
administration now says waivers will be good through 2013, and it will
stop granting new ones as of September 22, 2011.
But the rest of
the strategy clearly is in place. Since the elections, the president has
not given a single speech on the major changes coming from his health
law. His main focus has been on tactic number 3–attacking Republicans
at every opportunity and claiming that he is the protector of Medicare
because he won’t “ask our seniors to pay more for health care.”
far, it seems to be working. Obamacare has evaporated as a major issue.
The House of Representatives voted overwhelmingly to repeal the law in
January and, according to a CBS News poll, about half of those asked
think it has been repealed or aren’t sure. The confusion suits the White
House just fine. Republicans are working to defund the law, delay its
implementation, investigate the avalanche of regulations that have
already been issued, and examine the impact the law is having on health
costs and the ballooning deficit, but their efforts didn’t make the
It is difficult to overestimate the sweeping impact
that Obamacare will have on our health sector, our economy, and our
freedom. (My co-authors and I have highlighted in our book Why ObamaCare
Is Wrong for America [Broadside/HarperCollins, 2011] the devastating
impact it will have on seniors, families, young people, taxpayers,
employers and employees, doctors and patients).
WILL THE SUPREMES
rescue us? While many hope Congress will repeal the law, others believe
there is a good chance its key provision–that all citizens purchase
federally approved health insurance–will be declared unconstitutional
by the Supreme Court. That is a big gamble.
The Sixth Circuit was
the first of several appeals courts to rule on the validity of
Obamacare’s mandate; conservatives were disappointed about its decision
in late June to uphold it. At least two other appeals courts will issue
decisions over the next several months, with a likely U.S. Supreme Court
hearing next year and a decision by June 2012.
Scholars expect a
5?4 decision, with Justice Anthony Kennedy the deciding vote. Courts
are reluctant to overturn major legislation enacted by Congress. The
Supremes will likely look at public opinion in weighing their decision.
If the law is still unpopular, it will be much easier for them to decide
(correctly) that the individual mandate is unconstitutional. But if the
country seems to have settled into acceptance, they could do the easy
thing and let the legislation stand.
That’s yet another reason
the White House is doing everything it can to calm opposition and
convince the public that the law is beneficial. The Supreme Court
verdict could depend upon its strategy of silence.
THIS STATE OF
AFFAIRS won’t last forever, though. If the president were to be
reelected and Obamacare therefore left in place, the American people
will have a shocking awakening in 2014?
?when they are facing a
mandate to purchase health insurance policies that will be one of the
most expensive items in their family budget.
?when job creation
continues to stall because employers are reluctant to hire workers due
to federal mandates, fines, and even higher health costs.
?when businesses have to find out their employees’ household income so they can avoid $3,000 per-employee annual fines.
states find that adequately funding schools, roads, and police
protection is almost impossible because dramatically expanded Medicaid
costs are crushing their budgets.
?when hospital emergency rooms are still flooded with patients but funds for this “uncompensated care” are vanishing.
?when tens of millions more line up for subsidized health insurance, adding $1 trillion or more to the cost of the law.
taxpayers realize that estimates of the cost of Obamacare were
dramatically understated, with more and more deficit-financed dollars
poured into an unreformed health care system.
In the face of this
tsunami of change, it’s crucial to direct the conversation back to the
health care law’s defects. There are two hot-button issues that will
surely force Obamacare back into the center of the political debate:
employment-based health insurance and Medicare–both of which affect two
huge constituencies with health coverage that is threatened by
Start with employer-based health insurance. The White
House knew that providing security to those with coverage was a key
selling point for passing legislation designed to provide insurance to
an estimated 32 million more Americans. Hence the mantra: “If you like
your health insurance, you can keep your health insurance.” But a recent
survey of employers conducted by the consulting group McKinsey &
Company found that up to 50 percent say they will definitely or probably
pursue alternatives to their current health insurance plan after
Obamacare takes effect in 2014. That means as many as 78 million
Americans could be forced to find other sources of coverage–half of the
156 million working Americans who get health insurance through
This also has huge implications for the deficit. This
new entitlement program will exacerbate the extraordinarily difficult
task of controlling federal spending. Before the health law passed, the
Congressional Budget Office estimated that only 9 million to 10 million
people, or about 7 percent of employees who currently get health
insurance at work, would switch to government-subsidized insurance. But
the McKinsey survey of 1,300 employers across industries, geographies,
and employer sizes found “that reform will provoke a much greater
response.” It concludes that the new law will lead to a “radical
restructuring” of job-based health coverage.
analyst, Alissa Meade, told a meeting of health insurance executives
soon after the November elections that “something in the range of 80
million to 100 million individuals are going
to change coverage
categories in the two years” after the insurance mandates take effect in
2014. Many employees who will need to seek another source of coverage
will take advantage of the health insurance subsidies for families
making as much as $89,000 a year included in the health care law. This
will drive up the cost of Obamacare by $1 trillion or more, according to
Douglas Holtz-Eakin, a former director of the Congressional Budget
The cost of Obamacare will also soar due to what liberals
call “a glitch” in the law: employees can obtain subsidized health
insurance if their employer plan is “unaffordable,” meaning it costs
more than 9.5 percent of their income. Let’s take an employee who now
has a family health plan through his job. Congressional analysts assumed
that as long as the employer’s coverage for the individual worker cost
less than the 9.5 percent trigger, he wouldn’t be eligible for subsidies
even if the Obamacare-mandated family plan cost 20 percent of his
income. Liberal advocates are worried about the impact of this budget
gimmick. As one admits, “We’re going to have middle-class families
extremely unhappy with health reform in 2014, because they’ll basically
be facing financial penalties for not buying coverage when they don’t
have access to any affordable options.”
The other unpopular
aspect of Obamacare is its treatment of Medicare, which is being used as
a budgetary piggy bank by Democrats. They count on using $575 billion
in future payment cuts to finance creation of the two massive new
entitlement programs in Obamacare. And the president has proposed taking
another $480 billion out of the program to lower the deficit.
Obamacare, payments to providers would be cut so deeply that seniors
will find it harder and harder to get care. Doctors would stop taking
Medicare or go bankrupt, according to Medicare actuaries. A whopping 87
percent of doctors say they will stop seeing or will restrict the number
of Medicare patients they see, further limiting access to care. Seniors
also fear the powerful, 15-member Independent Payment Advisory Board
(IPAB) that will use price controls to meet ever-elusive spending
targets. Rationing is inevitable, especially of newer medicines and
Medicare is $38 trillion in the red, and it
accelerated five years toward insolvency in just the last year,
according to the Medicare Trustees’ latest report. Sen. Marco Rubio
captures it best in a new video, saying, “Anyone who is in favor of
doing nothing to deal with this fact is in favor of bankrupting it.”
that is indeed the president’s strategy. He repeatedly hammers House
Budget chairman Paul Ryan for his plan to begin modernizing the program
starting in 10 years. Ryan wants to give baby boomers the option of
private coverage much like the plan members of Congress have today.
Access to coverage would be guaranteed, and payments would be tailored
to meet a person’s age, health, and income level. Meanwhile, the
president’s plan would tighten the tourniquet on Medicare with price
controls that will make it more and more difficult for seniors to find a
provider. This will inevitably lead to government rationing of care.
HOW is this issue going to play in the 2012 elections? There is
legitimate concern about former Massachusetts governor Mitt Romney as
the Republican nominee. The president appears to relish opportunities to
remind people that he used Romneycare, the state health care program
Romney signed into law, as the model for his own plan.
is an easy target for Democrats. Both Romneycare and Obamacare require
residents to have health insurance or pay a penalty. Both force most
businesses to participate or pay a fine. Both expand coverage through
Medicaid and government-controlled insurance exchanges. Both subsidize
highly prescriptive (and costly) insurance policies. And both require an
expanded government bureaucracy to manage the whole Rube Goldberg
While Romney insists Obamacare must be repealed, it
will be very difficult for him to put much daylight between his plan and
the president’s. Romney still is trying to defend his position that his
plan was right for Massachusetts, but that he wouldn’t impose it on the
rest of the country.
Romney’s plan for his first 100 days as
president also is troublesome. First, he says he would begin to undo
Obamacare with an executive order: “If I were president, on Day One I
would issue an executive order paving the way for Obamacare waivers to
all 50 states,” he claims. “The executive order would direct the
Secretary of Health and Human Services and all relevant federal
officials to return the maximum possible authority to the states to
innovate and design health care solutions that work best for them.”
Gov. Romney must know he can’t use an executive order to wipe out two
massive new entitlement programs, $550 billion in new and higher taxes,
vast Medicaid expansion, and mandates on individuals, businesses, and
the states to comply with the Patient Protection and Affordable Care
Act. Waivers are not a solution.
Second, he says: “Of course, the
ultimate goal is to repeal Obamacare and replace it with free-market
reforms that promote competition and lower health care costs. But since
an outright repeal would take time, an executive order is the first step
in returning power to the states.” Take time? The Republican House
passed a repeal bill within a few weeks of taking power. If there were a
majority in the Senate supporting repeal, they could repeal virtually
all of its massive spending provisions with 51 votes, using the
reconciliation process that allowed Obamacare to pass. Then a new
president could have a bill to sign on his desk within a month or two of
FOR NOW, expect the administration to continue to play down Obamacare’s changes and show flexibility at every turn.
instance, there is the substantive concession that the president has
made by quietly repealing the burdensome 1099 provision that would have
required small businesses to track and report all transactions with
vendors totaling $600 in a year. And last spring, the administration
manipulated formulas to allow a small increase in the Medicare Advantage
payments that were cut by the law. This avoided a firestorm among
seniors who would otherwise lose their popular plans. But it means
putting off the larger cuts that the law requires until after the
Secretary Sebelius has said she now
realizes changes need to be made to the law’s long-term care
program–another new entitlement which even the Democratic chairman of
the Senate Budget Committee, Kent Conrad, called “a Ponzi scheme of the
first order.” And in July, she testified before two House committees
that the dreaded IPAB won’t be needed if Congress does its job in
cutting Medicare payments to meet strict targets.
3–attack Republicans–is in full gear. Sebelius said in congressional
testimony recently that the Republican Medicare plan could cause people
to “die sooner.” When challenged at a later hearing to defend the
statement, she took the offense to criticize the Ryan Medicare plan.
Clearly, it is imperative that conservatives prevent Sebelius and Obama
from defining the issue on such distorted terms. It would be disastrous
to allow the president to try to hide from his “signature achievement,”
or distract the public by demonizing Paul Ryan and his Medicare plan.
country’s future will be determined by what happens in 2012. The
American people tried to tell Washington in every way they could that
they strongly opposed Obamacare–from town hall meetings, marches on
Washington, and electing Republicans to office in very blue states, to
creation of an entirely new political movement. Washington didn’t
listen. Now the White House hopes we will forget.
That’s why it
is so crucially important that Obamacare not slip to a second-tier issue
in the political debate. The threats to our liberty, our economy, and
our future prosperity could not be greater.
Published in The American Spectator, September 2011.