Isn’t it about time we acknowledge the fact that Obamacare was a massive overreach by the federal government? The Affordable Care Act was a thousand pages long. Even though the law was passed four years ago government officials, legislators and the public are still trying to figure out what is in it. There are already 10,000 pages of implementing regulations with many more to come. Just writing the regulations requires tens of thousands of government workers; implementation, including trying to sign people up, is requiring tens of thousands more. Managing this additional and massive bureaucracy will be a challenge in itself.
It is equally clear that the American people don’t necessarily behave as the legislation intended or as bureaucrats expected. The two demographic groups central to the purpose and success of the law, previously uninsured individuals and the young and healthy, are precisely those not signing up. According to a recent study, more than 80 percent of those who have signed up were previously insured. This means the basic, and unintended, effect of the law has been a sideways move that merely shifts millions of people from private or employer-provided plans onto the federal exchanges. Faced with a vote of no-confidence by its core constituencies, the Obama Administration has essentially given everyone who wants it a two year pass on the heart of the law, the individual mandate. So many of Obamacare’s core attributes have been delayed, diluted or even cancelled that Republicans do not need to campaign this fall on repealing the law. The President has, in effect, repealed it himself.
The experience with the rollout of the federal web site, Healthcare.gov, was emblematic of an immovable object, the federal bureaucracy, running headlong into an irresistible force, a law that took on too much too quickly. Although the Department of Health and Human Services (HHS) tried to lay blame for the web site’s problems on some of the private contractors hired to develop it, in truth no company could have done more given the way the program was managed. Healthcare.gov was the most sophisticated real-time, transaction-based system in government, comprised of 6 systems involving 55 contractors, 5 government agencies, 36 states, and more than 300 insurers with more than 4,440 insurance plans. Moreover, the integrated technology platform behind the web site —for the first time ever and in real-time—sought to combine the processes of selecting and enrolling in insurance and determining eligibility for government subsidies. Even though more people are able to use the web site today than five months ago, there is no evidence that the end-to-end system is functioning. In fact, just this week HHS Secretary Kathleen Sebelius admitted in testimony before Congress that she did not know how many people had actually acquired and paid for insurance through the federal system.
Mind you, many of the implementing regulations were not even written until the 11th hour, due in part, to disagreements regarding policy and procedures among the various federal agencies and departments with jurisdiction. At least 40 percent of the regulations that had been written were still in draft and under review until last summer, only weeks before the scheduled date of the web site’s rollout. This made it nearly impossible for the web site designers to adequately account for these last minute decisions in the system’s structure or to test the software adequately before the web site went live in October. Although the presiding federal officials were warned of a potential debacle if the site was unveiled prematurely, they decided to go ahead anyway.
The inconsistent experience of the state exchanges reflects the same general point. Those that sought to do the simple things, like an online shopping outlet, have tended to be successful. Those that catered to the instincts of the bureaucracy for more, bigger, and all-encompassing, features have been disasters.
To give you another example of the bureaucratic overreach and its effects on our health care system, in the most recent edition of The Weekly Standard, Stephen Hayes has written about the planned implementation of a new federal code for identifying medical procedures, diseases and treatments. This is considered by the Administration to be a central feature of its plan for health care reform. The number of individual codes will explode from 17,000 to 155,000. The one page diagnostic and billing form your doctor fills out while treating you and which is essential to his reimbursement by insurance companies, Medicare and Medicaid, will now expand to the size of a small phone book. One of the codes provides for treatment of injuries sustained while falling in the water as a result of burning water skis. So at the same time, the medical community, insurers and the American people are trying to cope with the intricacies and ever changing mandates of Obamacare, they get this little extra gift from the federal bureaucracy.
It is becoming clear that even a behemoth that is the federal government cannot manage health care. The bureaucracy needs to stick to something simple, something they can succeed at, like ending poverty or winning the war on drugs.
 Stephen Hayes, “Code Chaos,” The Weekly Standard, March 10 2014
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