Tuesday, October 22, 2013

Three years of what?

Updated 10/25 (see second footnote)
Updated 11/2
Photo by Kelly Hunt, Maryland.
For example, in Insurance Journal:
“They don’t seem to be addressing these problems quickly enough. They’ve had three years to get their ducks in a row. It gets to the point where it becomes inexcusable. And we’re not at that point yet. But we’re getting close to it,” said a senior Democratic aide in Congress.
Or the Daily Mail:
Welcome to the disaster: Healthcare.gov is more than three years and $394 million in the making, but few Americans have been able to make it function, leaving a trail of discouraged consumers in its wake.
Or New England Cable News:
Senator Mitch McConnell said, "They've had three or four years here to get this ready. God only knows how much money they've spent. And it's a failure."
OK. It's true that from the president's signature on March 21, 2010 to the launch of the website on October 1 this year is just about exactly three and a half years.  And?

In March 2010 the Marketplace website wasn't even supposed to exist, at least not in anything like the form it has taken. The law was written to placate those who feared or pretended to fear that the federal government was going to "take over" the delivery of health care in the United States, and in order to save us all from this dreadful outcome, the marketing of health insurance to the 47 million Americans who don't have it was assigned to the several state governments, each of which would design and maintain its own exchange. In case a particular state was just not able to handle it, the feds would come in and partner with the task; and for a state that totally failed to show up there was a provision allowing the feds to just do the whole thing. Nobody however, in the Congress or the White House, imagined three years ago that 26 states would simply refuse to carry out their responsibilities under the Act.

This was apparently because of the widespread belief that state governments are always more practical than ideological; leaders may inveigh against government programs as much as they like, but they have to balance their budgets and they are supposed to have more direct connection to the voters, administering things with which the voters are directly involved like roads and schools and local development projects. Was there really a Republican governor who would turn down hundreds of millions of federal dollars just because of some self-evidently false and arguably psychotic utterance from Sarah Palin?
Duck array management. From Rattle's Garden.
As we soon learned, New Jersey's governor Christopher Christie would. In October 2010 he turned down $6 billion to build a new Hudson River tunnel, offering 6000 construction jobs immediately and incalculable benefits in the long run, even committing his state to pay a penalty of $350 million for reneging on the deal, simply to get the attention of the national Republican hierarchy by displaying what a dick he could be.*

Things were changing in 2010 in the Republican party and in the statehouses and state capitols where they held sway, and the number of those statehouses and capitols greatly increased in November (increasing the number of legislatures they controlled from 14 to 25 plus 8 divided and governorships from 23 to 29). They believed they owed their success to the so-called Tea Party and its hysterical campaign against "Obamacare" as people were starting to call it, and they found themselves not behaving in the traditional state-politician pork-gobbling way.

Meanwhile (as NPR's Julie Rovner was pointing out this morning) it continued to be possible that the Supreme Court would rule the new law unconstitutional in summer of 2012, or that Mitt Romney and the Republicans would win the elections that November and "repeal and replace" it as they had promised to do. And the states meanwhile dithered; even after the 2012 elections Republican governors were begging HHS for more time to submit their plans for the health insurance exchanges that needed to open in October 2013; Secretary Kathleen Sebelius gave them to December 14, which is when 26 states finally informed her that they weren't going to do it. (With the Medicaid expansion governors have felt freer to be normal, presumably because that part of the program doesn't have Obama's name on it. and eight Republican governors have so far this year changed their minds and decided to accept it; but it is still slated not to happen in 25 states.)

Which meant, among other things, that there wasn't going to be enough money. The original bill provided HHS with a round figure of $1 billion to implement the law, while the Congressional Budget Office estimated it would cost $5 to $10 billion to get it running over the first decade; but every time the administration begged Congress for a billion here and a billion and a half there, Congress turned them down. By May of this year Sebelius was out begging the health care industry for donations to help make up the shortfall.**

So no, they didn't have three years to line up those ducks, they had nine and a half months. And underfunded. For a job that wasn't supposed to be needed. And entirely due to Republican obstruction. Give me please one break, sirs.

*In April 2012, faced with indisputable evidence that his arguments against the tunnel were false and known to him to be false at the time he made the decision (if only because he knew that the state's cost was not going to be 70% of the total, as he had said it would be, but 14.4%), Christie showed his real motivations by simply repeating the falsehood and the punch-drunk pose for an audience of Republican donors:
“So when they want to build a tunnel to the basement of Macy’s, and stick the New Jersey taxpayers with a bill of three-to-five billion dollars over — no matter how much the administration yells and screams, you have to say no,” he said in a speech at a conference on taxes and the economy in Manhattan held by the George W. Bush Institute.
“You have to look them right in the eye, no matter how much they try to vilify you for it, and you have to say no.”
**Minor update: The Washington Post just found out about Sebelius's  hat-in-hand tour of last spring, meaning I can now say I scooped them! 
Photo by Cade Martin. Via Rosalind Grace Design.
Updated 11/2/2013:

I didn't dare to suggest that the Republican Party was actually working to sabotage the program, but now Todd Purdum, writing for Politico, has done so, and it looks pretty persuasive.

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