The beginning of enrollment for insurance coverage for up to 9 million people under the Affordable Care Act is just a few weeks away, but questions about implementation of the law are starting to overshadow the Democratic narrative that it will bring big benefits.
The latest in a series of unplanned postponements in the implementation of the law: a delay in imposing a limit on out-of-pocket costs for Americans paying deductibles and co-pays, according to a New York Times report.
In July the administration announced it was delaying for a year the requirement that employers pay penalties if they do not offer health insurance to their workers or if they offer a plan which doesn’t meet the ACA’s standards.
And the administration is also changing the enrollment process for some of those who sign up to buy taxpayer-subsidized coverage. Some of the people applying for subsidies will use self-verification or “attestation” of their income and insurance status next year, rather than being checked by the Internal Revenue Service.
Meanwhile Senate Republican Leader Mitch McConnell is urging Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, to delay the scheduled Oct. 1 opening of Obamacare’s insurance marketplaces, or exchanges, until there’s more assurance about protection of private data.
Last week Reuters reported that the inspector general for the Department of Health and Human Services had warned about delays in testing data security for the exchanges. "Several critical tasks remain to be completed in a short period of time," the inspector general said.
Americans, McConnell said, “should not be forced to enter into exchanges when CMS is so ill-prepared to guarantee the protection of personal data and taxpayer resources from hackers and cyber criminals … .”
At a House hearing early this month, Tavenner assured Rep. Diane DeGette, D-Colo., that data would be secure: “the history of CMS is we handle millions of records. So we have very tight security controls, (obey the 1974) Privacy Act, we follow all the security requirements agreement.”
The struggle over implementation is operating on two levels:
First there are the difficulties of carrying out a complex law which requires the coordination of federal and state officials, private-sector insurance companies, employers, and labor unions.
Secondly, there’s the battle for hearts and minds – with Republicans trying to convince the public that law isn’t working, won’t work in the future, and ought to scrapped or at least delayed.
Leading the crusade for the Obama administration, HHS Secretary Kathleen Sebelius told the National Conference of State Legislatures meeting in Atlanta Monday that state lawmakers ought to educate people on the law.
“Just because new coverage options may be available doesn’t guarantee that people will even know about them, let alone take advantage of them” she said. “Getting them covered shouldn’t be about politics or ideology or winners and losers.”
She added, “Remember, the debate in Washington is over. The president signed the law. The Supreme Court affirmed it. The people have spoken and President Obama was re-elected. Now it’s about making sure that people know about the choices and opportunities that are about to become available to them … .”
Democrats argue that just as they worked in good faith to implement the 2003 law signed by President George W. Bush which created a prescription drug benefit in Medicare – even though most Democrats opposed that law – so too Republicans now ought to help make Obamacare work.
“When we passed the Medicare Part D bill, and the Democrats frankly didn't like it, we didn't like the fact that the administrator couldn't negotiate prescription drug prices,” DeGette recalled. “But despite that, we all went out to our districts and we worked with our constituents to let them know how they could enroll. Why? Because this would help our constituents. And in fact now, Medicare Part D has become very, very popular.”
Democrats hope that Obamacare, too, will become very popular once it’s fully operating.
But conservatives in Congress, such as Sen. Mike Lee of Utah, are preparing for a series of votes next month to defund Obamacare, linked to the spending bill, or continuing resolution, that Congress must pass before the current one expires on Sept. 30.
“When you create a new entitlement program, these programs become very, very difficult to stop once they're implemented,” Lee told Fox News Monday night. “That's why we need to stop these because we don't have the money. We need to stop them before they open, before this process starts on January 1st, and our last chance to defund this program before it kicks in January 1st is in connection with the continuing resolution. So we've got between now and September 30th to make sure that we don't fund it.”
In his reelection bid in Kentucky, McConnell us under pressure from his GOP challenger Matt Bevin to sign a pledge, spearheaded by Lee and Sen. Ted Cruz, R-Texas, to not vote for any spending bill that includes funding for Obamacare implementation.
Lee told Fox News he didn’t want to stop funding all other government operations and thus shut down the government. He just wants a chance to vote: “Members of Congress ought to have the opportunity to say, I want to vote for everything else in government except ‘Obama care,’ and that's all I'm proposing.”