Saturday, January 07, 2017

Obama's Legacy - Obamacare

Early in his presidency, Mr. Obama announced to his staff that he needed something big as his legacy. "Isn't saving the world's economy enough?" they asked. "No, it has to be bigger than that," the President told them.

Obama wanted to be remembered as the Roosevelts are for national parks and Social Security, respectively or LBJ and Medicare/Medicaid. He wanted something big.

Surprisingly, health care wasn't the first thing that came to mind for him. The Democratic party had been waiting impatiently since the early 1990s when Hillary Clinton's proposed health care reform collapsed under it's own weight. But health care reform was never a priority for Obama. He'd only included it in his platform to counter Hillary's proposal in the primaries. He'd even mocked her individual mandate. But health care reform was big - big enough to be his legacy.

Since he wasn't that interested in it, he left the details up to Congress and provided no guidance at all except that it should be something to address the uninsured instead of a total overhaul of the health care system. Even that was going to be a hard sell. And it was. Several Congressmen cut deals in exchange for their votes. It was decided early on that the Republicans would be cut out of writing the legislation which meant that they were unanimously against it. The Democrats had enough votes to go it alone but just barely.

The result was a mess but that was acceptable since it could be cleaned up during the reconciliation process with the Senate's version.

Then things got difficult.

Most Americans were happy with their insurance and worried that they'd end up with worse coverage. Opposition started to show up during the August recess when Democrats held town hall meetings to try to sell the legislation. It got worse when it came out that the Congressional leaders had no intention of actually reading the legislation. Public opinion turns against the bill. The final blow came when Ted Kennedy died and a Republican was elected to replace him on an anti-Obamacare platform.

That should have been the end of it. But Obama needed his legacy and the Democrats were convinced that the legislation would eventually become popular and assure them generations of majority status. With only 59 votes in the Senate they could not get past a filibuster so they used a legislative sleight-of-hand and used the House's bill, as written which only required a simple majority vote.

Obamacare became the law of the land without a single Republican vote and with more than half of the country against it.

The bill was flawed and they knew it but Obama and the Democrats preferred to pass something than nothing and they kept telling themselves that it would pay off in the long run.

It didn't. Obamacare never became popular and while Obama was reelected in 2012, the Democrats lost everywhere else.

As different parts of the law went into effect, left-leaning writers bragged about the number of people who were covered but neglected to mention that enrollment was always millions short of projections. This was an important shortfall. In order to work, a lot of young, healthy people needed to be enrolled to pay for the older, sicker ones. The program had no problem signing up the sick ones but the shortfall of healthy members meant that the participating insurance companies had huge losses. This lead to several insurance companies pulling out and others raising their rates much faster than inflation.

In selling the program, Obama promised "if you like your doctor, you can keep your doctor". This was named the lie of the year.

One rather cruel part of Obamacare was the Cadillac Plan tax. If your employer-provided plan was too good then it was taxed at a punitive rate to pay for subsidies. This meant that millions of people (and I'm one of them) had their insurance cut because their employer couldn't afford the taxes. In my case, the cuts amount to hundreds a month in out-of-pocket costs and I'm not alone.

Obamacare called for the states to set up insurance exchanges. Many Republican-controlled states refused so Obama simply ordered that the federal government would provide an exchange instead. The roll-out of the federal system was a complete disaster and it was months before the exchange was working properly.

The states that did set up their own exchanges had similar problems and several of those have since folded.

There was an employer mandate in Obamacare but Obama used an executive order to push that back, regardless of not having any actual authority to do this.

Despite being 2,000 pages long, a lot in Obamacare was left to bureaucrats to write. That included what birth control methods would be mandated. At first the Obama administration wanted this mandate to be universal but religious institutions objected. A waiver was allowed for them but the definition of who could get a waiver was very strict. A church could but a school run by that same church could not. This lead to two court cases. In one, Hobby Lobby objected to three out of fifteen types of mandated birth control on the grounds that they caused abortions. The Supreme Court ruled in their favor. The Little Sisters of the Poor, a group of Catholic nuns, objected to providing any birth control. This is still pending after being sent back to the lower courts. When no one in the Obama administration or the Democratic party noticed was that these administrative choices sent a clear message that the Democratic party was anti-religion. This cost them in the 2016 election when Evangelicals and Catholics turned out heavily for the Republicans.

As of this writing, it is unclear exactly what will become of Obamacare. The Republicans have vowed to Repeal and Replace Obamacare. Even if Hillary Clinton had won and the Democrats had swept back into office, the program couldn't survive without a major overhaul.

Obama saw Obamacare as his legacy, something that future generations would look back on. Instead, it will be looked back on as a cautionary tale against rushed, unpopular legislation.

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