Sen. Russ Feingold (D-Wis) is probably sitting in a hot tub someplace, telling himself everything is going to be OK in 2012 and wishing he had never voted for ObamaCare.
His vote on that piece of legislation could have defined him as a real maverick — when his vote counted – instead of an occasional maverick who swam against the tide when his vote made no difference.
More than any other Obama initiative, it was PPACA (Patient Protection and Affordable Care Act) that became the pivot point in the just completed elections. The law was sledge-hammered through Congress when the polls were showing genuine distrust of what was coming down. Republican contender Ron Johnson made Feingold’s vote for ObamaCare a central point of differentiation as he swept to victory. Nov. 2.
The law was ideological in its conception, not pragmatic as the president promised going into the debate. Proven reforms in the private sector were not incorporated in the legislation.
Many of the best innovators in health care delivery are doing their work in this state, and Feingold was oblivious. Had he listened to reformers here, instead of the political operatives inside the beltway, he could have helped to craft a law that solved the access issue in a way the country could afford. Improved health should also have been a goal.
He would have come off as a serious problem solver. Because he went along with the party leaders, his claim to maverick status, which he earned with his opposition to the unnecessary war in Iraq and to the torrents of money entering the U.S. election process, came undone.
All claims to the contrary, the health insurance reform will prove to be hugely expensive for American taxpayers, and they figured that out. Feingold’s ardent support for PPACA framed him as a big spender, even as he tried to position himself otherwise with his opposition to earmarks. Voters know that PPACA has a cost in the trillions, while the earmarks have costs in the tens of millions. Voters can do proportions, even if they didn’t go to Harvard.
And voters know a bureaucratic monstrosity in the making when they see it. The PPACA law, because of its complexity, required 2409 pages. John Barlament, a benefits expert with the Milwaukee law firm of Michael Best, noted recently that after the Medicaid law passed, it required 60 pages of regulations for every page in the bill. For ObamaCare, that multiplies to 144,000 pages of regulations coming down to spell out PPACA really means.
As might be expected, the federal regulators are way behind in writing the regs. Businesses are thoroughly confounded. Some are already dropping coverage to avoid the administrative burdens that are already apparent.
One called me last week to see if he was on the right track in dropping his health care insurance and going to a defined contribution plan. He is facing premium hikes of 23% and 46% in his two divisions of 30-40 people. So he really doesn’t have much choice. ObamaCare ducked the screaming health inflation issues. The new law offers little solace to small businesses. The minimal subsidies to businesses under 50 employees will be wiped away by the hyper-inflation in the medical world.
The top-down reforms of health insurance (not health care delivery or economics) are so taxing (pun intended) that they have become a monumental distraction to real reform. Instead of figuring out how to keep people healthy and out of hospitals, expensive and dangerous places, employers are going to endless seminars to figure out how to play the yet undefined insurance game.
One wag reminded me of a moment in an Indiana Jones comment when our hero was facing an inescapable predicament: “Don’t worry, our best people working on it.”
Here are just a few of the black holes in the new law:
- The minimal fine on employers who drop coverage — $2000 per employee – is not nearly high enough to deter an employer from defaulting to new government plans, such as the massive expansion of Medicaid. Expect it to be bumped to at least $5000 and maybe more.
- Shifting 18 million people onto Medicaid may be more than states can handle financially. BadgerCare, Wisconsin’s version of Medicaid, is already hemorrhaging red ink. Several states are considering termination of the federal-state program, even though the federal government picks up half the tab.
- Every plan must include what the regulators decide is “minimum essential coverage.” Every interest group in health care is lobbying hard to be included. Is infertility covered? If so, premiums will rise. Chiropractic? Daily Viagra?
The uncertainties surrounding the new law increased dramatically with Republican wins in many statehouses and in the House of Representtives. While the House Republicans can’t stop PPACA on their own, they can refuse to fund some of its essential line items.
And Republicans in statehouses can take a go-slow approach. The new Republican majorities in the Wisconsin Legislature, for instance, mean that the mandated health care exchanges under PPACA will be put in deep freeze until required in 2013. The Doyle Administration was going full out to be the first state to implement in 2010 or 2011.
The future of ObamaCare will remain in doubt until the presidential and Congressional elections of 2012. Republicans will use on-going opposition to the vast expansion of the government’s role in health care as a way to win those races.
Why wouldn’t they? The over-reach on health care contributed heavily to the defeat of Democrats like Feingold, so it’s a proven game plan.
Further, Democrats who survived the Nov. 2 bloodbath will be considerably more reluctant to fight amendments to the new law. Gaping deficits at the national and state levels will be another rationale for going slow.
Meanwhile, real reforms of health care at the ground level continue. They have to; because the inflation of the last 40 years in health care has become intolerable. If the politicians want to expand access, that’s where they need to look to make it affordable for the nation.