Medicare Part D's Hopeful Lessons for Obamacare
The rocky rollouts of the two laws were strikingly similar. The big difference this time around is an opposition party with its mind set on sabotage.
Congress is back—and the House has an ambitious plan for the year ahead. OK, an ambitious plan to cement its place in history as the Do-Nothingest Congress of all time.
The House has scheduled all of 97 days in session before the November elections, with many of them being half days or pro forma ones. And Majority Leader Eric Cantor's memo to his troops outlining the plan for the year ahead made it clear that there is at most a bare-bones agenda, focused like a laser, yet again, on repealing or further sullying and delegitimizing Obamacare. The only possible good news coming out of that is that the obsessive focus on killing Obamacare may provide the excuse for House leaders to extend the debt ceiling without blackmail this time, by convincing their rank and file that it is the best way to avoid distractions and keep the focus on the health-insurance law.
The obsession with Obamacare, and the near-universal belief among Republican lawmakers and conservative spinmeisters that the law will collapse spectacularly of its own weight, is fascinating.
Remember that when Senator Ted Cruz incited the shutdown last year over the demand to defund Obamacare, his argument was that this was the last chance before the law was implemented in January—after which it would be impossible to stop it, because so many Americans would be delighted with its benefits. Cruz told Sean Hannity last July, "If we don't do it [defund Obamacare] now, in all likelihood, Obamacare will never, ever be repealed. Why is that? Because on January 1, the exchanges kick in, the subsidies kick in; ... their plan is to get the American people addicted to the sugar, addicted to the subsidies, and once that happens, in all likelihood, it never gets …"
At which point Hannity agreed, saying, "It's over—it never gets repealed."
The awful and bumpy rollout of the plan changed all that; now, for Cruz, Hannity, and everyone else in the right-wing echo chamber, there won't be any highs ahead, or at least the highs and sugar addictions will be overwhelmed by bad drugs and overdoses.
Which view is right? We don't know for sure, but there is some interesting evidence in the rollout of the Medicare Part D plan in 2005, via an excellent analysis by Georgetown University's Center on Health Insurance Reform. The report makes clear that there are many parallels between Part D and Obamacare.
First, both plans passed with substantial partisan tension, which tarnished the initial public views of them. Second, both plans created much confusion in the public, with small proportions of Americans having even a basic understanding of what was in the plans and how they would work. Third, both plans had a lot of time after passage and before they actually took effect to prepare for a massive rollout. Fourth, neither had its website ready to roll when the deadline hit, and both had crashes and long delays to gain access. Fifth, even after the websites became more reliable, other problems persisted, including inadequate call centers and inexperienced navigators at the local level who were unprepared with full or sophisticated answers to questions posed by those trying to sign up. Sixth, supporters of the laws issued cautions when they were first unveiled, warning of glitches ahead and asking the public for understanding and help at ameliorating the problems.
Now for the differences. While Medicare Part D was the subject of serious partisan chicanery—the infamous three-hour vote in the House; the conference committee that barred key Senate Democrats from participating, including Senate Democratic Leader Tom Daschle; the "bait and switch" that in the end took out all the parts of the bill that had made Ted Kennedy an initial partner of the Bush Administration—once it was law, most Democrats worked hard to make the plan accessible and workable for seniors, as did Democratic governors and state legislatures.
Of course, the opposite is true of Obamacare. Despite yeoman efforts to make the bill bipartisan—months and months of negotiation by Senate Finance Chairman Max Baucus with Chuck Grassley and other Senate Republicans, starting from a framework devised and endorsed by Grassley—it got not a single GOP vote. But after passage, it has received nothing but yeoman efforts to sabotage it, including from a slew of Republican governors denying insurance to the most needy of their constituents simply to stymie the law's implementation. And whenever a Republican talks about how to make the law work better, instead of blowing it up (Jack Kingston of Georgia comes to mind), he or she is vilified by partisans and their media acolytes.
Second, the mainstream media reported on the glitches in the Medicare Part D plan but did not jump all over them with front-page or highlighted stories, or repeated and lengthy inquests on Sunday talk shows. The opposite has been true of Obamacare, with an added twist that reflects the new economic and political realities for media, as reported in a piece by Maggie Mahar at healthinsurance.org. Mahar investigated a ballyhooed article in the Fort Worth Star-Telegram titled "Obamacare Stirs Anxiety for Thousands." The cases of those who were purportedly shafted by Obamacare proved to be false or exaggerated, and three of the four cases cited were Tea Party adherents who strongly opposed the law, two of whom had never even checked for prices on the exchanges. After a lengthy stonewall by the paper's editors, it became clear that no one had fact-checked the piece, which was written by a reporter with no expertise in health policy, under a tight timeframe, assigned by an editor who only wanted bad news, not any stories of those who had been helped by the new law. This is more a case of underresourced news outlets eager to report bad news than bias, but it reflects the tougher climate for a law that affects far more people in far more ways than Part D did.
Eight years after its rocky rollout and deep public skepticism, the Medicare Part D plan is widely popular. I have no idea if that will be the case with Obamacare—and if achieving popularity takes any length of time, the political damage, in this November election and maybe even in 2016, will already have been done. What I do know is that there are going to be a whole lot of winners under the Affordable Care Act, and a smaller number, but still a significant one, of losers or those caught up in the inevitable upheaval to the healthcare system.
And I know if your only legislative or policy plan for 2014, in the face of a sluggish economy, a crisis of long-term unemployment, and a host of other short and long-term problems facing the country, is to bet on the spectacular failure of the healthcare plan, you deserve the public contempt your Congress is receiving.