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Annals of Health Reform Chutzpah

Posted by John McDonough  October 24, 2013 10:45 PM

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I have not written about the ACA website fiasco because ... what do I know? I hope Team Obama can fix it soon. 

Now that the shutdown/debt ceiling crisis is over, critics are going after the Obama Administration for the problems plaguing the federal health insurance exchange website. One of the most persistent critics has been the Washington Post's Ezra Klein, otherwise an ardent supporter of the ACA.

Today, though, Ezra took the gloves off with the anti-ACA crowd who are crying crocodile tears about the inability of federal Exchange website applicants to get their insurance coverage applications through the process. All I can say is -- wish I had written that:

The classic definition of chutzpah is the child who kills his parents and then asks for leniency because he's an orphan. But in recent weeks, we've begun to see the Washington definition: A party that does everything possible to sabotage a law and then professes fury when the law's launch is rocky.

On Tuesday, Rep. Paul Ryan became the latest Republicans to call for HHS Secretary Kathleen Sebelius to step down because of the Affordable Care Act's troubled launch. "I do believe people should be held accountable," he said.

Okay then.

How about House Republicans who refused to appropriate the money the Department of Health and Human Services said it needed to properly implement Obamacare?

How about Senate Republicans who tried to intimidate Sebelius out of using existing HHS funds to implement Obamacare? 'Would you describe the authority under which you believe you have the ability to conduct such transfers?' Sen. Orrin Hatch demanded at one hearing. It's difficult to imagine the size of the disaster if Sebelius hadn't moved those funds.

How about congressional Republicans who refuse to permit the packages of technical fixes and tweaks that laws of this size routinely require?

How about Republican governors who told the Obama administration they absolutely had to be left to build their own health-care exchanges -- you'll remember that the House Democrats' health-care plan included a single, national exchange -- and then refused to build, leaving the construction of 34 insurance marketplaces up to HHS?

How about the coordinated Republican effort to get the law declared unconstitutional -- an effort that ultimately failed, but that stalled implementation as government and industry waited for the uncertainty to resolve?

How about the dozens of Republican governors who refused to take federal dollars to expand Medicaid, leaving about 5.5 million low-income people who'd be eligible for free, federally-funded government insurance to slip through the cracks?

The GOP's strategy hasn't just tried to win elections and repeal Obamacare. They've actively sought to sabotage the implementation of the law. They intimidated the people who were implementing the law. They made clear that problems would be exploited rather than fixed. A few weeks ago, they literally shut down the government because they refused to pass a funding bill that contained money for Obamacare.

The Obama administration deserves all the criticism it's getting for the poor start of health law and more. Their job was to implement the law effectively -- even if Republicans were standing in their way. So far, it's clear that they weren't able to smoothly surmount both the complexities of the law and the political roadblocks thrown in their path. Who President Obama will ultimately hold accountable -- if anyone -- for the failed launch is an interesting question.

But the GOP's complaints that their plan to undermine the law worked too well and someone has to pay border on the comic. If Republicans believe Sebelius is truly to blame for the law's poor launch, they should be pinning a medal on her.

And there's more...

Here's another one.  Seven years ago, the George W. Bush Administration was implementing the launch of the new Medicare "Part D" prescription drug program.  Implementation was chaotic and a mess.  So how did Republicans respond to implementation disaster?  Talking Points Memo has the details in a post earlier today:

 People can kick the Obama Administration all they want over the website.  I just can't ignore which side really wants health insurance coverage for all Americans and which side doesn't. I give the Administration the benefit of the doubt as they work to get it fixed. 
This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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