Pity poor Kathleen Sibelius. Just a short time ago she was to be the face of Barack Obama's signature achievement, bringing inexpensive and comprehensive healthcare to the masses. A well-regarded former Kansas governor and one of the few remaining original cabinet members, she had the plum job - no responsibility for the "going nowhere" economy; no part of the willful reduction in world influence; no need to mislead Congress about political abuses. Just fulfill Obama's promises and all would be well. So, how's that going?
- Well, no matter how many times Obama claimed it, few probably expected that costs would go down and nobody would have to change their providers as we covered 30 million more people without appreciably increasing the number of doctors. There are wildly conflicting projections on costs (starting with $1.1 trillion over 10 years) as the full force hits in January - Medicare projected budget costs are decreasing as arbitrary price controls are instituted; insurance rates are increasing modestly for large company programs, but increasing at double or triple digit rates for young individuals or small companies and comparisons are obscured by mixing rates, deductibles, and co-pays. Virtually everyone is confused.
- Implementation will be massively uneven with 26 states choosing to let Sibelius' Department of Health and Human Services run the exchanges set up as clearinghouses for insurance company offerings for individuals and small companies. Many small companies will be dropping coverage and paying fines rather than providing the increased coverage required (mental health and contraception for example) and the increased rates. Many are staying below a 50 employee limit for more onerous provisions by avoiding hiring and making many employees part time.
- Now that Nancy got it passed and we are finally seeing what is in it, there are some 20 new taxes, costing $500 billion over 10 years, including a 3.8% investment income surtax and higher Medicare taxes for high income households; penalties for individuals and companies choosing to not buy mandated coverages; new taxes on insurance companies, drug companies, medical device manufacturers, and charitable hospitals; and myraid restrictions on Health Savings Accounts and medical expense tax deductions. Obama's FY2014 budget increases IRS employment by over 5000 (1650 tagged directly to Obamacare) with a requirement to deal with credits for low income payers, penalties for non-subscribers, and myriad increased code complexities. Sorry, no new doctors.
- In the spirit of 2013 Washington D.C., the Republicans have limited funding for "enrollment outreach", causing Sibelius to actively solicit funds from companies which she will regulate for Enroll America - one of those nasty tax-exempt non-profits that the IRS hates so much. Trust her, the donations won't influence her department's decisions.
From here, the timeframe is what matters. Democrats point wistfully to Social Security and Medicare as massive increases in federal spending and control which were initially opposed by Republicans but now are nearly universally accepted. Republicans point to the 2014 elections with the expectation that the Democrats won't be able to put enough lipstick on the pig to cover even the minimal expectations. Neither side is interested in near term fixes - the Democrats because they fear any changes will lead to a flood; the Republicans because they prefer to let it collapse.
As the folks in Chicago begin to design the Obama presidential library it is obvious that there will be plenty of empty shelves. The wipe out on gun control pretty clearly indicates that the White House's mojo is gone with no Republican support and no Democratic fear of crossing their president. The Benghazi, IRS, and media intimidation scandals will drag on with Jay Carney and Darrell Issa defining the administration. Some credit will be taken for immigration reform which the Republicans need and there will be one or two more Supreme Court justices to get through the Senate, but the public's attention will be increasingly focused on Secretary Sibelius' efforts to make lemonade out of the lemons which we will have at least through 2016.
This week's video is President Obama's announcement of a move intended to bolster the public's confidence in the administration's judgement as it balances between civil liberties and national security.