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Campaign-style tactics used in Obamacare implementation fight

This 2012 file photo shows campaign material about Obamacare, seen at a Tea Party rally in New Hampshire.Jessica Rinaldi / Reuters

Campaign-style ads, legislative votes to get politicians on the record, and bitter rhetoric are nothing new when it comes to electioneering. But these partisan plays are being utilized in the battle over Obamacare; a fight centered on the implementation of an already-passed law, not a congressional seat up for grabs.

Republicans are seizing on two changes the Obama administration announced for the rollout of the insurance program:

  • A one-year delay in the penalties that larger employers (those with 50 or more full-time employees) must pay for offering their workers either no health insurance coverage or coverage which the law deems inadequate.
  • A change in the enrollment process for some of those who sign up to buy taxpayer-subsidized coverage. People applying for the subsidies will use self-verification or “attestation” of their income and insurance status next year, rather than being checked by the Internal Revenue Service.
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“I think that the administration right now is in a triage mode. Seriously, they do not have the resources to implement all of the provisions on time,” Washington and Lee University law professor Timothy Jost, a supporter of the ACA, testified Wednesday at a House Ways and Means Committee hearing on the delay in employer penalties.

In reaction to the delay and the change in income verification, Republicans are arguing that the Obamacare rollout is turning out to be the “train wreck” that Senate Finance Committee Chairman Max Baucus, D-Mont., warned of last April.

If the Obamacare employer penalties are delayed, so, too, should be the requirement that uninsured individuals buy insurance, Republicans say. House Speaker John Boehner announced Thursday that the House will vote next week on delaying both the employer penalty and the requirement that uninsured individuals buy insurance. “Is it fair for the president to give American businesses an exemption from his health law's mandates, without giving the same break to the rest of America? Hell no, it isn't,” Boehner said.

Those votes will put House members of both parties on the record and create TV ad fodder for 2014 midterm elections.

The propaganda battle is already well under way on television. The conservative group Americans for Prosperity is now running a TV ad campaign against Obamacare; last month Organizing for Action, a spinoff of the Obama presidential campaign, launched its pro-Obamacare ad barrage.

The first test vote on the delay took place Thursday at the Senate Appropriations Committee markup of the Health and Human Services spending bill for Fiscal Year 2014.

Sen. Jerry Moran, R-Kan., proposed amendments to stop enforcement of both the insurance mandate on businesses and the requirement that individuals buy insurance. Both measures were rejected on party line votes. The National Republican Senatorial Committee criticized Sen. Mark Begich, D- Alaska, who is up for re-election next year, for voting against the Moran amendment to block the individual mandate.

Jost warned in his testimony Wednesday that a delay in the individual mandate could be catastrophic. Insurers and state insurance regulators would be, he said, “very, very worried if the individual mandate would be delayed, because as weak as it is, it is what's going to keep insurance markets from collapsing once we open the door to people with pre-existing conditions and offer federal tax credits to help people get insured.” For the insurance market to work, healthy uninsured people must be prodded into purchasing insurance.

Sen. John Thune, R-S.D., said Wednesday that Obama and his allies “want to take the parts (of the ACA) that are hardest to implement and that create the most amount of pain” – such as the employer penalties – “and put them off, but still kind of hang the benefits out there to try and get people really addicted to the good things that they think are in the bill,” such as the taxpayer-subsidized coverage for about 7 million now-uninsured people.

Democrats counter that since Republicans want the Obamacare implementation to be a fiasco, they’re doing everything they can to disparage the rollout.

“The major obstacle that the Affordable Care Act faces today is there's so much opposition for political reasons alone to see that this thing fail, and not whether this is going to help small businesses or help Americans,” said Rep. Ron Kind, D-Wis., at the Ways and Means Committee hearing Wednesday.

What has been somewhat lost in the debate is that this is a pre-election year ruckus over a relatively small group of people – the 7 million whom the Congressional Budget Office projects will purchase insurance through electronic marketplaces or exchanges next year. Compare those 7 million to the 157 million who will have employer-provided coverage and another 40 million or so will still be uninsured even after provisions of Obamacare take effect in 2014.

But Julie Barnes, executive director of Washington health policy consulting firm Breakaway Policy Strategies, said of the 2014 rollout, “Success is going to come in many forms. This is not a lot of people across our entire country. It’s not going to feel like a lot in the first year, almost no matter how many millions of people it is.”

But still, she added, “a hospital would say, every 10 more patients they can have insured is that much more uncompensated care they don’t have to provide, that many more physicians that can keep employed, and that many more days they can keep their doors open.”

Among the “known unknowns,” with the enrollment period beginning in only two and a half months:

  • How many of the uninsured will sign up in the insurance exchanges, beginning on Oct. 1?
  • Is the penalty on uninsured people for not purchasing coverage -- $95 in 2014, or 1 percent of taxable income -- big enough to motivate people to actually buy insurance? “Most women pay more for their shoes” than the amount of the penalty in the first year, cracked Barnes. (By 2016, the penalty will increase to $695 per individual, $2,085 per family, or 2.5 percent of household income.)
  • Will a significant number of employers drop health insurance as an employee benefit, this making many more people eligible for coverage and subsidies in the exchanges?