Week In Review: Politics Of Health Reform Implementation, Insurance Mandate, More CBO Estimates

This week, the Obama administration continued planning how to turn the health law into policy and practices.

On Monday, the White House issued rules related to the new law’s provision paving the way for young adults to stay on their parents’ health insurance until age 26. The New York Times reported that “the promise of this coverage has attracted great interest” as employers and insurance companies have been flooded with inquiries. And “Kathleen Sebelius, the secretary of health and human services, estimated that 1.2 million people would gain coverage because of the new requirement” (Pear, 5/10). 

(KHN’s Morning Edition on May 10 and May 11 featured details on the young adult rules.)

The unveiling of the guidelines was one of the ways the administration seemed to be staking a claim in the increasingly intense public opinion tug-of-war. Sebelius sent a letter to congressional leaders citing the progress on such “early insurance market reforms.” Politico described it as part of an effort “to convey the impression that the debate is over and the health care train is leaving the station. … [It] was sent to House Speaker Nancy Pelosi, Minority Leader John Boehner, Senate Majority Leader Harry Reid and Minority Leader Mitch McConnell, as well as leaders of the health-related committees” (Haberkorn, 5/10).

Meanwhile, the White House was exploring how to help congressional Democrats use the health overhaul to win support during the midterm election season. The Hill reported that lawmakers met Tuesday evening with White House officials “to discuss the latest steps the administration has been taking to put in place the early deliverables of health reform.” And some members sought a specific commitment that President Barack Obama would continue helping to sell the bill” (Pecquet, 5/11).

Voter anxiety could be a hitch in this plan, according to USA Today: “polls show voters aren’t totally on board with [Obama’s] achievements, at least not yet, and the White House acknowledges that his victories have carried huge financial and political costs” (Page and Hall, 5/12).

Congressional Republicans have their own public relations strategy. Roll Call reported that under “the slogan ‘second opinion,’ Republicans plan to communicate their message on multiple fronts, including on the Senate floor, in press conferences, via the Internet and through television and radio appearances.” And the GOP has already begun criticizing Donald Berwick, Obama’s pick to run the Centers for Medicare and Medicaid (Drucker, 5/13).  The Boston Globe reported that Senate Minority Leader Mitch McConnell on Wednesday called Berwick an “expert on rationing” and a Senate Republican Policy Committee paper said he would steer the agency toward a “brave new health care world” (Milligan, 5/13).

(The May 11, May 12 and May 13 Daily Health Policy Reports include more coverage of these developments.)

This week also was marked by legal challenges to the health law’s requirement that individuals buy insurance. “Efforts to block a key provision of the new health-care overhaul law are underway in 33 states, as a growing roster of mostly Republican officials have mounted legal and legislative challenges to an eventual requirement that virtually all Americans buy health insurance or pay a penalty tax,” according to The Washington Post (Aizenman, 5/12).

 The New York Times detailed one of these cases, which was initially brought by Florida. “Some legal scholars, including some who normally lean to the left, believe the states have identified the law’s weak spot and devised a credible theory for eviscerating it. … The power of their argument lies in questioning whether Congress can regulate inactivity – in this case by levying a tax penalty on those who do not obtain health insurance.” But The Times also points out that the legislation’s drafters were careful to protect the law from this type of constitutional challenge. The central issue, according to the report, relates to the Supreme Court’s interpretation of the Commerce Clause. If the court takes a broad view, “the health insurance mandate is likely to survive” (Sack, 5/10).

And today, the National Federation of Independent Business announced its intent to sign onto the Florida lawsuit. The Associated Press noted that the involvement of this small business lobby all but guarantees that the constitutional issues — regardless of how they are received in courtrooms — will be played out in upcoming congressional campaigns (Alonso-Zaldivar, 5/14).

Reuters reports that the Justice Department this week released an official response to a suit, brought by “a conservative public interest group, the Thomas More Law Center,” to block the law from taking effect. The group charged that the mandate “was beyond the scope of Congress’ power and was an unconstitutional tax.” The Justice Department reply noted that “Congress acted to address a national problem, the minimum coverage provisions were constitutional and the lawsuit was premature because no one had been harmed by the law” (Pelofski, 5/12).

(For more news coverage, see the May 11 and May 13 Morning Edition.)

Finally, a new round of Congressional Budget Office cost estimates released this week muddied the debate surrounding the health law’s actual price tag.  The Associated Press reported on Tuesday that, based on the new projections, the measure “could potentially add at least $115 billion more to government health care spending over the next 10 years.” The estimates included “$10 billion to $20 billion in administrative costs to federal agencies carrying out the law, as well as $34 billion for community health centers and $39 billion for Indian health care” (Alonso-Zaldivar, 5/11).

Almost immediately, backers and detractors sprang into action. “Republicans pounced on the news, which they called another sign that the Obama administration makes promises it cannot deliver,” according to Politico (Haberkorn, 5/11). But the White House offered strong statements of its own, saying, as reported by The Hill, that the health overhaul “will reduce the deficit by more than $100 billion in the first decade, and that will not change unless Congress acts to change it. … The President has called for a non-security discretionary spending freeze, and he will enforce that with his veto pen” (Pecquet, 5/11). And, as the back-and-forth became increasingly heated, complicated and even weedy, Office of Management and Budget Director Peter Orszag and CBO Director Douglas Elmendorf took to their blogs in an attempt to flesh out further, from each of their own perspectives, what the spending projections meant.

(KHN provided coverage on May 12 and May 13.)  

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