Let's begin with the unpopularity, then move on to the substantive issues. Sooner or later, the latter will impact the former. A new poll reveals that the same people who re-elected this president by a three-point margin still oppose his signature "accomplishment" by double-digits. Independents remain particularly sour on the law, the worst bits of which are slated for implementation over the next two years. In Jeffrey Anderson's write-up of CNN's poll, he explains why voters didn't unequivocally embrace Obamaism on November 6th (via Mary Katharine Ham):
According to polling by CNN, registered voters oppose Obamacare by a margin of 10 points — 52 to 42 percent. Independents like Obamacare even less, opposing it by a margin of 22 points — 57 to 35 percent. Clearly, voters didn’t think they were ratifying Obamacare when they pulled the lever for Obama.
I say the worst elements are slated to be implemented in 2013 and 2014 because implementation itself is proving to be a truly jaw-dropping nightmare of astonishing proportions. The Wall Street Journal noted a major component of the coming dysfunction:
The current rumpus is over ObamaCare's "exchanges," the bureaucracies that will regulate the design and sale of insurance and where 30 million people (and likely far more) will sign up for subsidized coverage. States were supposed to tell the Health and Human Services Department if they were going to set up and run an exchange by October, but HHS delayed the deadline to November, and then again at the 11th hour to December. Sixteen states have already said they won't participate. Another 11 are undecided, while only 17 have committed to doing the work on their own. Six have opted for a "hybrid" federal-state model. That means HHS will probably be responsible for fallback federal exchanges in full or in part in as many as 25 or 30 states. The opposition isn't so much political as practical. Or rather, the vast logistical and technical undertaking to build an exchange helps explain why so many Governors resisted ObamaCare in the first place. States have regulated the small business and individual insurance markets for decades (some well, others less so). Now they're supposed to toss everything out for a complex Washington rewrite, which is still being rewritten.
The exchanges will also help enforce the individual mandate and premium increases. They'll also have to spend a ton of money. Ohio estimates it will cost $63 million to set up an exchange and $43 million to run annually, based on a KPMG study. Most spending will go to information technology, in an era when many states still run Medicaid using paper forms and pneumatic tubes. These systems are supposed to allow consumers to review health plans online (or in person and by mail and fax), pick one and then ping HHS and the Internal Revenue Service to determine who is eligible for what subsidies. Private businesses spend years developing and refining such consumer software. States need to fund call centers to field queries and even hire "navigators" to actively encourage people to enroll. The main problem is that states are being conscripted as federal contractors. HHS has declined to reveal basic operational details except to make clear that state-based exchanges won't really be run by the states.
In fact, the initial major round of governing regulations were only published around this Thanksgiving, 32 months after Obamacare became law. States were supposed to solidify plans for their exchanges by last month (the deadline was again pushed back), even though the feds hadn't released their detailed guidelines for legal compliance. The delay was triggered by a combination of technical ineptitude and a political desire to hide many of the unpleasant regulations from voters prior to the election. Now that they've finally been released, participating states are scrambling to catch up. The countdown clock to Obamacare Live! is ticking. But what about the states that have declined to implement exchanges, exploiting a loophole the shoddily-written law? The federal government will be responsible for setting up those exchanges, a task that they never expected (!) would be asked of them:
The markets, known as exchanges, are a centerpiece of President Obama’s health care law, and running them will be a herculean task that federal officials never expected to perform. When Congress passed legislation to expand coverage two years ago, Mr. Obama and lawmakers assumed that every state would set up its own exchange, a place where people could shop for insurance and get subsidies to help defray the cost.
And this screw-up doesn't even touch the constitutional question of whether the federal government can even offer subsidies to citizens in non-state exchanges, which the law actually doesn't permit as written. (Didn't someone say something once about having to pass the law to find out what's in it?) MKH is also tracking another epic snafu-in-the-making, and it's a real doozy. Behold, the state of the federal tech hub that will serve as a crucial database for those "Travelocity-style" websites, which citizens will use to navigate the exchanges:
This is a giant tech undertaking which will need to serve many localities with different needs, link existing technologies and personnel with a new, giant federal hub, and somehow make sure all of them work together to smoothly to guide consumers who have no idea what to expect in subsidies or services through a brand new web portal for health insurance. They have less than a year to accomplish this. It seems there has been no pilot program, no training, and no beta testing.
Meanwhile, Phil Klein pores through another new, mind-numbing regulatory tome and discovers a surprise surtax buried within:
Despite over 2,000 pages of legislative text, many key details of President Obama’s national health care law were left up to regulators to work out, with Secretary of Health and Human Services Kathleen Sebelius given the lead role. The Obama administration wanted to avoid issuing potentially controversial health care regulations during an election year, but now that it’s over, regulations are starting to roll out. In a news dump this past Friday afternoon, HHS released 373 pages of new insurance regulations, and buried on page 299 is a proposed 3.5 percent monthly “user fee” to be levied on the premiums collected by insurers who offer policies on the new government-run exchanges. Effectively, it’s a regulatory surtax that will inevitably be passed onto individuals who purchase insurance on these new exchanges.
And up go your premiums, just like that. We won't know the full extent of this monstrosity's total price tag, logistical inefficiency and bureaucratic morass until Obamacare is basically past the point of uprooting -- just as the president intended it. This isn't any old legislation that's been thoroughly mucked up from start to finish; it's the law of the land that governs 1/6 of the US economy and your healthcare. The results of CNN's poll notwithstanding, the practical effect of America's decision last month enshrines this mess -- at least until it collapses and Democrats rush to the rescue with a great new idea that will fix everything.