Obamacare and the Setback in Civics

Once again, if a Republican president did this kind of thing, we would be complaining about an imperial presidency:

For the second time in a year, the Obama administration is giving certain employers extra time before they must offer health insurance to almost all their full-time workers.

Under new rules announced Monday by Treasury Department officials, employers with 50 to 99 workers will be given until 2016 — two years longer than originally envisioned under the Affordable Care Act — before they risk a federal penalty for not complying.

Companies with 100 workers or more are getting a different kind of one-year grace period. Instead of being required in 2015 to offer coverage to 95 percent of full-time workers, these bigger employers can avoid a fine by offering insurance to 70 percent of them next year.

How the administration would define employer requirements has been one of the biggest remaining questions about the way the 2010 health-care law will work in practice — and has sparked considerable lobbying. By providing the dual phase-ins for employers of different sizes, administration officials have sought to lighten the burden on the small share of affected employers that have not offered insurance in the past.

As word of the delays spread Monday, many across the ideological spectrum viewed them as an effort by the White House to defuse another health-care controversy before the fall midterm elections. The new postponements won over part, but not all, of the business community. And they caught consumer advocates, usually reliable White House allies, by surprise, particularly because administration officials had already announced in July that the employer requirements would be postponed from this year until 2015.

More here, along with a key passage:

The International Franchise Association, a trade group, said the move didn’t go far enough. “By picking winners and losers based on the size of a business, the administration has effectively placed another complicated hurdle on the backs of the small-business community in coming to terms with this law,” said the group’s president, Steve Caldeira.

Again, if the Obama administration believes that these rules changes are necessary, it should have to get Congress to approve these rule changes in the form of new legislation. Instead, the administration is working to implement the changes on a unilateral basis. That is not the way things are supposed to work, but when it comes to implementing Obamacare, the Obama administration decided to dispense with constitutional niceties a while ago. And its political allies have repeatedly pretended not to have noticed.

Ron Fournier is quite right:

It’s getting difficult and slinking toward impossible to defend the Affordable Care Act. The latest blow to Democratic candidates, liberal activists, and naïve columnists like me came Monday from the White House, which announced yet another delay in the Obamacare implementation.

[. . .]

Not coincidentally, the delays punt implementation beyond congressional elections in November, which raises the first problem with defending Obamacare: The White House has politicized its signature policy.

The win-at-all-cost mentality helped create a culture in which a partisan-line vote was deemed sufficient for passing transcendent legislation. It spurred advisers to develop a dishonest talking point—“If you like your health plan, you’ll be able to keep your health plan.” And political expediency led Obama to repeat the line, over and over and over again, when he knew, or should have known, it was false.

Defending the ACA became painfully harder when online insurance markets were launched from a multi-million-dollar website that didn’t work, when autopsies on the administration’s actions revealed an epidemic of incompetence that began in the Oval Office and ended with no accountability.

Then officials started fudging numbers and massaging facts to promote implementation, nothing illegal or even extraordinary for this era of spin. But they did more damage to the credibility of ACA advocates.

Many of those advocates continue to believe that they are on the side of Light and Truth. I guess this is the kind of thing that happens when one lives in a bubble and is epistemically closed off from the rest of the planet. But no one can seriously claim anymore that the rollout of Obamacare–from its website and registration process, to the policy implementation activities of the administration–has been anything short of utterly disastrous.

Speaking of disasters . . .

After KPIX 5 ConsumerWatch revealed confusion over which physicians are accepting patients under Covered California, some doctors who did not want to accept patients on the exchange said they were surprised to find out they were on the exchange’s list of providers.

Last week, KPIX 5 reported on Covered California enrollees who found many doctors on the insurance exchange’s list wouldn’t accept them as patients. As a result of our report, Covered California removed the list of doctors from their website.

Independent physicians across California say they can’t afford to participate in Covered California’s insurance plans because the reimbursement rates are too low, and they say they don’t have the clout doctors with larger medical groups have to negotiate higher rates. They also warn that could mean a shortage of doctors in areas largely served by independent physicians.

Dr. Marie President is one of those doctors unhappy with reimbursement rates. The Redwood City internist said she was surprised to even find herself on a provider list published on the Covered California site. “We were astonished because we hadn’t signed anything yet,” President told KPIX 5.

Additionally, she says the reimbursement rates offered under the state’s plan aren’t realistic. Taking patients under those circumstances isn’t practical, President said. “We can’t, or we’ll be out of business.”

As always, whenever you hear of problems with the implementation of health care “reform” in California, remember that Paul Krugman believes that California is a case study in how Obamacare can succeed.

UPDATE: This is what life looks like in an alternate universe.

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