I’m looking at two Talking Points Memo posts and breathing a sigh of relief at a Republican/reactionary strategic error:
One was narrowly political: win the 2010 and 2012 elections and repeal the law. The other was less visible but no less important: sabotage the law at the state level to engineer failure and force repeal or a combo of policy and political catastrophe for the Democrats. The first failed in November 2012. Now we know they whiffed on the second one too.
It’s simply too late to undo what happened in March 2010…
all the efforts at sabotage – trying to convince young people not to sign up, trying to scare people that they’d have their identities stolen, trying to prevent so-called ‘navigators’ from helping people enroll, refusing to set up state-based exchanges, opting out of Medicaid expansion and generally trying to scare the crap out of people with death panels and everything else so they wouldn’t sign up. All had one aim: undermine enrollment to force what health care economists call a risk pool death spiral.
I am a healthcare attorney for an insurance company and I wanted to share our experience with the implementation of the ACA. I know the idea is that state legislators have been working to subvert the ACA, but it actually goes deeper.
We are in a few states. One is Kentucky, a state based exchange, and the other states have conservative governors who opted to be part of the federal exchange. Even though states opt to be part of the federal exchange, the states are still responsible, in some cases, for day to day insurance activities (approval of forms, rates, etc). In the process of undergoing all of these changes and trying to make sense of all the new requirements between the federal and state exchanges, Kentucky has been excellent. The Kentucky Department of Insurance has helpful staff that answers the phone and gets back to us if we have questions or issues. The other departments of insurance in states with conservative governors have basically ignored our calls.
Most of the states that ran their own exchanges had significant local backing for healthcare expansion. There were exceptions such as Idaho and Nevada where the attitude was more along the lines that this program was coming so might as well make it work well enough for local needs and local elites. Some of the states screwed the pooch on their website launches. Oregon’s system suffered from massive scope overrreach and barely works, and Maryland may trash their exchange and go federal next year. However, there was often a political and technical will to make things work as well as possible. And on the whole, the states that were invested in success are seeing success.
The strategic error that I think the reactionaries made was keeping their hands completely clean from Obamacare implementation. I understand the political pressure from the teabaggers as any conservative who came within ninety three feet of Obamacare could expect a primary challenge in 2011 or 2012 from a True Believer ™. But the decision to hand the Exchanges and outreach to the Federal government where there was political will to get things to work was a minimally forced error. Sabotage from the outside can occur, and there was plenty of it, but effective sabotage from the outside is tough to pull off. Texas and Mississippi can’t really fuck with the Federal exchange on healthcare.gov. They can nibble navigators to death, they can make approving plans a pain in the ass, and refuse to quickly answer questions but they can’t cripple the system as they don’t get to see the guts of the system.
Imagine how sabotage would have been effective if Texas built their own Exchange by outsourcing the contract to the low bid firm of the illegitimate son of a minor political hack who had built SQL databases as a hobby? Imagine how effective sabotage would be if the Texas Exchange went live on Oct. 1 with the same cluster fuck set of complications as healthcare.gov but without any urgency to get the software working until 2019?