Election Coverage / Government Watch / Politics

As Midterms Loom, Democrats Worry About Health Law

by Jackie Calmes – The New York Times –

WASHINGTON — As the administration struggles to put in place the final, complex piece of President Obama’s signature health care law, an endeavor on a scale not seen since Medicare’s creation nearly a half-century ago, Democrats are worried that major snags will be exploited by Republicans in next year’s midterm elections.

Many Democrats also want to see a more aggressive and visible president to push the law across the country. This week Mr. Obama is returning to the fray to an extent unseen since he signed the law in 2010, including a White House event on Friday to promote the law’s benefits for women, the first in a series of appearances for health care this year.

A number of health insurance changes have already taken place, but this fall, just as the 2014 election season heats up, is the deadline for introducing the law’s core feature: the insurance marketplaces, known as exchanges, where millions of uninsured Americans can buy coverage, with subsidies for many.

For the third time, Republicans are trying to make the law perhaps the biggest issue of the elections, and are preparing to exploit every problem that arises. After many unsuccessful efforts to repeal the law, the Republican-led House plans another vote soon. And Republican governors or legislatures in many states are balking at participating, leaving Washington responsible for the marketplaces.

“There are very few issues that are as personal and as tangible as health care, and the implementation of the law over the next year is going to reveal a lot of kinks, a lot of red tape, a lot of taxes, a lot of price increases and a lot of people forced into health care that they didn’t anticipate,” said Brad Dayspring, spokesman for the National Republican Senatorial Committee. “It’s going to be an issue that’s front and center for voters even in a more tangible way than it was in 2010.”

That year a conservative backlash against the new law helped Republicans take control of the House. But last year Mr. Obama was re-elected, and Democrats gained seats in Congress.

Democrats are worried about 2014 — a president’s party typically loses seats in midterm years — and some have gone public with concerns about the pace of carrying out the law. Senator Harry Reid of Nevada, the majority leader, told an interviewer last week that he agreed with a recent comment by Senator Max Baucus of Montana, a Democratic architect of the law, who said “a train wreck” could occur this fall if preparations fell short.

The White House has allayed some worries, with briefings for Democrats about their public education plans, including PowerPoint presentations that show areas with target populations down to the block level.

“There’s clearly some concern” among Democrats “that their constituents don’t yet have all facts on how it will work, and that Republicans are filling that vacuum with partisan talking points,” said Representative Steve Israel of New York, head of the House Democrats’ campaign committee. “And the administration must use every tool they have to get around the obstructions and make it work.”

The latest poll from the Kaiser Family Foundation, released last week, showed that Americans remain split on the law, although four in 10 are unaware that Mr. Obama’s Affordable Health Care Act is indeed a law.

The Kaiser polls tracking Americans’ attitudes in recent years have been generally consistent, with Democrats supporting the law and Republicans against it. But the percentage of respondents who are undecided has been building lately, to about a quarter. Administration officials said those were the people they were hoping to win over.

Democrats argue that repeal attempts will only hurt Republicans and alienate the very voters they are trying to appeal to — women, young adults and Latinos. Those are the groups most supportive of the law.

“If they think they’re going to run the 2014 election on refighting the political battles of 2010, they’re going to fare very poorly,” said Dan Pfeiffer, Mr. Obama’s chief strategist. “We’re going to implement the law well, and we don’t worry.”

It will not be easy. Michael O. Leavitt, who as health secretary to President George W. Bush oversaw the establishment of Medicare’s prescription-drug program, said that until now, that was the largest such undertaking since Medicare’s start in 1965.

“And I will tell you that there were several times during the course of that implementation that the system nearly collapsed,” said Mr. Leavitt, who is advising several states on how to put the law into place. “We had lots of problems.”

Yet carrying out the health law, he added, “is significantly larger, and more complex.”

Republicans have held the administration to about one-third of the money that the Bush administration received for the lesser challenge of starting up the Medicare drug program.

The stakes for the president are high. The ultimate success of the law, and in turn his domestic legacy, depends on how well the insurance marketplaces operate, and whether enough young Americans enroll for coverage.

While Friday’s event at the White House will draw attention to the law’s benefits for women who already have insurance, aides say that increasingly Mr. Obama’s outreach will be to uninsured Americans and those who buy their insurance because they do not get it from employers.

He will especially urge healthy young adults, those up to 35 years old, and minorities — groups in which he has “a lot of cachet,” Mr. Pfeiffer said — to sign up starting Oct. 1 for the new exchanges. Beginning Jan. 1, most Americans must have insurance or pay fines.

Without the participation of that generally healthy young population, insurance premiums for everyone else would increase — threatening support for a law already short of it.

The Department of Health and Human Services is doing the nuts-and-bolts work of setting up the system. But essential regulations remain unresolved, leaving insurers, small businesses and health care providers unsure of how to proceed.

Mr. Obama also will meet privately with groups with a stake in the outcome, aides say, to foster cooperation. For the first time, he has hired someone — Tara McGuinness, a seasoned Democratic operative — solely to lead a White House team on communications strategy. Organizing for Action, the grass-roots network formed from his 2012 campaign, will also join with other community and professional groups as well as celebrities and athletes to inform people about the law.

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Linda Cain
9 years ago

I would hate to think that anyone in their right mind would back a law that gives committee (DEATH PANEL) the right to say who gets health care and who does not. This com. can say that because of your AGE or disability,etc, you are no longer a VIABLE citizen so no health care for you. They already are not allowing anyone over the age of 70 to get cancer treatments. This mess must be repealed NOW!!!

Robert Jones
9 years ago

Well, PaulE,

What is your alternative? To continue the massive train wreck we have now? Where 40% of the population has no insurance at all, which dumps their healthcare cost on the rest of us when they seek out help at the Emergency Room, which by law must be given?

Don’t you think that getting them into the insurance system would be more cost-effective? Don’t you think that getting them in front of physicians BEFORE they get sick would be the SMART thing to do?

Perhaps you think that the way insurance works is to only have the wealthy who can afford it participate? Do you think this is the way our current auto insurance works? Do you think it is a good idea to insure both the good driver and the bad driver, or both the young driver and the old driver?

Or perhaps only owners of million-dollar homes should have home insurance? What is it about “spreading the risk” (which is the basic principle driving insurance company efficiency and profit) that you don’t like?

And of course, you do understand that the current health care law (aka Obamacare) is modeled after Romney’s Massachusetts Plan, which was taken VERBATIM from the conservative Heritage Foundation’s writings on the subject over the past twenty years?

Perhaps you agree that the current system, which often drives people into bankruptcy when they are non or under-insured, is working well? Do you have an alternative? I await your informed and well-written response.

9 years ago
Reply to  Robert Jones

Hi Robert,

First off, your 40 percent uninsured figure is inaccurate. Even most members of your own Democrat Party agree that the figure is actually 15 percent. The vast majority of those are young, healthy people who opt not to purchase health insurance and instead spend their money on other things. So unless you’re including illegal aliens in your number, which American taxpayers should not be paying to subsidize their healthcare in any form including emergency rooms, you over-state the severity of the so-called problem. We’re changing a system that has worked well for 85 percent of the population for several decades to accommodate 15 percent, many of which have voluntarily chosen NOT to have health insurance.

By the way, before you jump all over me for NOT wanting illegals to be treated in emergency rooms, may I point out that they are NOT SUPPOSED to be this country to start with. Yes, they came here illegally and consume healthcare resources, via emergency rooms and clinics, that the American people then end up picking up the tab for, but that also happens to be one of the reasons why overall healthcare costs continue to escalate. Do you expect hospitals to simply write-off these charitable care expenses and still be able to remain open? Take a look at the balance sheets of many of the hospitals that have folded over the last 10 years. Growing unreimbursed charitable care costs are one of the leading reasons for their closings.

The rest of your rant, which is what it is, basically consists of Democrat talking points and typical class warfare rhetoric. If you hate the United States so much, why don’t you simply move to one of the many socialist democracies of Europe or Latin America? May I suggest if you think that single-payer is so attractive, you go to live in Europe for four or five years and experience the wonderful system first hand. When you need to see a specialist and it takes several weeks or even months to do so, while you’re either in pain or suffering from a something serious like a tumor or degenerative disease, you might develop a new appreciation for our “train wreck of a system” we have now where you can see a specialist in days and receive urgent treatment much faster. In Europe, your doctor having to wait for the official stamp of approval or denial from the government, for any expensive treatment should really thrill you.

By the way, you throw out RomneyCare as if you expect me to think it was good or acceptable. It’s not! Romney didn’t do the people of Massachusetts any favors when he enacted that mess. It is no better than Obamacare and is slowly bankrupting the state of Massachusetts and is actually impeding access to quality healthcare for the overall population there.

As for solutions, here are a few even though I doubt they will please you, since your ultimate goal is single-payer and as the President says, “the fundamental transformation of the United States”:
1) Catastrophic care insurance policies that would cover those illnesses that so often lead to personal bankruptcy. These would be more major illnesses only. So the premium cost would be low for the young, healthy people who choose not to buy any health insurance today. These policies would also be attractive to people with pre-existing conditions that have no insurance at all today. State governments could mandate any insurance company operating within its borders would have to offer such policies as a condition of doing business in the state.

2) Tort reform. Yes, I know you don’t want to hear this, but doctors are forced to practice defensive medicine, which drives up costs across the board, because malpractice insurance rates have exploded over the last 20 years. Doctors now routinely order numerous tests, many of them unnecessary or duplicative, simply to ensure that they won’t face a potential malpractice judgment down the road. These costs all get passed along to everyone in the form of higher insurance premiums, and higher medical bills.

3) Allowed tiered health insurance policies. Right now what we’re headed for with Obamacare is insurance policies that will be mandated to cover virtually every known illness or condition by HHS. Rather than allowing people to buy the level of insurance they need or want, they will be shoe-horned into a one size fits all mega coverage policy. Already insurance companies are being bombarded with new mandates from HHS every week. All this adds to the cost of health insurance. If you could buy the level of insurance you want and actually need, as opposed to what some politician, either Democrat or Republican says you have to buy, insurance costs for the individual would not be going up double digit every year. In some cases, they would actually go down or stay level for a number of years. Both state and federal governments have contributed to this problem over the years, so this is not merely a federal government or Obamacare issue. Obamacare just layers on a lot more mandates across the board faster, which will of course will make insurance rates rise even faster than usual.

9 years ago

The democrats should be worried. Obamacare is a disaster waiting to be implemented. It has some good items that need to be saved, but most needs to be repealed before more damage is done. Democrats need to vote for repeal to save their seats

9 years ago

If the Republican leadership is smart, which I know is a highly questionable assumption given past performance, they would do nothing to aid Obama and the Democrats in trying to bail out this horrible law. As your article correctly states, HHS is still creating the rules and regulations for Obamacare and are a long way from completing that task. With over 17,000 new rules and regulations being introduced by HHS into the healthcare industry and many more on the way, Obamacare is indeed a massive train wreck in progress as Max Baucus stated a few weeks ago. Mind you, he was one of the main drivers of creating this train wreck of a law.

The setup of the exchanges, which are the centerpiece of handling the millions that will find themselves scrambling to find healthcare insurance after their employers discontinue their current employer provided coverage, are in complete disarray. Democrats are waking up to the reality that Obamacare could very well end up being an albatross around their necks for years to come and they desperately want the Republicans to get involved, so they can later lay off some of the blame on them.

The only thing the Republicans should do is offer to work with Democrats on a bill that would lead to the total repeal of Obamacare.

9 years ago

I don’t trust anyting that the liberal Democrats present to us in this day and age. I have my thoughts about the president, but I am keeping them to myself since the IRS, the American Gestpo, will be collecting more data on everyone in the country. You beter believe that this is a new form of persecution to be use against private citizens.

9 years ago

I wouldn’t trust anything coming from the Democrats. The last decent Democrats either die or gave up the ghost of what once was a very patriotic organization.

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