( – promoted by Rob “EaBo Clipper” Eno)
Josh Archambault of the Pioneer Institute and I recently offered some thoughts on the implementation of the national health reform law in an op-ed in the Manchester Union-Leader. Check it out and let us know what you think:
Another View: Delaying the implementation of Obamacare makes sense
By ERIC DAHLBERG and JOSH ARCHAMBAULT
Published Sep 13, 2011
The federal health reform law that President Obama signed in March 2010 puts extensive new responsibilities onto the shoulders of the 50 states. The law requires each to make significant changes to its Medicaid program and undertake far-reaching reforms of its commercial health insurance market. In addition, each state must decide whether to set up a new marketplace for health insurance – an exchange – or allow the federal government to set up a “federal fallback exchange.”
All these responsibilities must be met within just a few years. Even under ideal circumstances, this timeline would be daunting. In the real world, it may be unworkable. Even in Massachusetts, one of two states that already has an exchange, unresolved questions about implementation of the federal law continue to mount.
Assuming health reform remains the law of the land, the Obama administration should give states the flexibility they need to implement reforms that are uniquely tailored to their needs and should extend the timetable for implementing reform by several years. There are many reasons why this is the most prudent course for the administration to take.
First, the country faces unprecedented economic and fiscal challenges that require the full attention of the federal and state governments. Getting the economy moving again must be the top priority. The administration should move everything else to the proverbial back burner.
Second, businesses, the engines of every state’s economy, consistently express grave concerns about health reform’s as-yet-unknown impact on them. President Obama spoke to the already heavy regulatory burden businesses bear during his recent bus tour of the Midwest: “… if there’s a bunch of bureaucratic red tape and it’s not actually improving the situation, let’s figure out how to get rid of some existing rules and let’s review every rule that comes in for its cost and its benefits.” Let’s heed the President’s words and acknowledge businesses’ concerns by extending the implementation of health reform in order to mitigate its impacts on already fragile state economies.
Third, guidance from the federal government to the states on health reform implementation has thus far been insufficient. Complicated sets of proposed federal regulations, each several hundred pages long and loaded with “TBDs,” are periodically released for analysis and further action by the states, where policymakers, already short on resources, scramble to understand what their next steps should be.
Fourth, ongoing legal challenges and conflicting court rulings about the constitutionality of the health reform law have left states wondering if it will remain intact. Just last week, the U.S. Court of Appeals for the 11th Circuit in Atlanta ruled that the centerpiece of the law, the individual mandate, is unconstitutional. It appears likely that the law’s constitutionality will not be fully resolved without a ruling by the U.S. Supreme Court, which could be many months away.
Fifth, the 2,000-plus pages of the health reform law itself contain many gaps that have yet to be effectively resolved. The press recently revealed that the law failed to identify funding for the federal fallback exchanges that will be set up in states unable or unwilling to create exchanges on their own.
Former House Speaker Nancy Pelosi’s infamous admonition in the lead up to the reform law’s passage, “We have to pass the bill so you can find out what’s in it,” has turned out to be even more cringe-worthy than first thought. Errors of omission and other inconsistencies that may exist in the law and accompanying regulations should be identified and resolved before states are held accountable for implementing it on such an aggressive timetable.
Finally, the timetable for state implementation should be extended because it would be consistent with the administration’s own explicit priority of working with states to get this thing right. Dr. Don Berwick, head of the Centers for Medicare and Medicaid Services, one of many federal agencies involved in implementing health reform, recently stated, “Flexibility is the name of this game and we are going to work very hard to meet the needs of each and every state.”
The federal government and states can implement health reform quickly, or they can implement it correctly. They cannot do both. So let’s slow down.
Eric Dahlberg is a Boston-based consultant who previously worked at the Massachusetts Health Connector, the nation’s first state-based exchange. Josh Archambault is the director of health care policy at the Pioneer Institute, a think tank in Boston. You can follow him on Twitter @josharchambault.