To learn how implementation of the Affordable Care Act got so bollixed up, you don’t have to look much further than the Oval Office, where an inexperienced President Barack Obama listened to the wrong advice and apparently made a fateful decision based on political concerns.
At least that’s the skinny filtering out of the mistake-tattered efforts to begin enrolling tens of millions of Americans in the new health care insurance system. According to The Washington Post, the young chief executive ignored his economic advisers’ warnings that making the federal system work would require business, technology and insurance expertise unavailable in the White House at the time. They urged him to set up a special team drawn from the best experts he could find.
Instead, Obama assigned supervision to those whose skill sets were woefully inadequate for such a monumental job. Two years later, overhaul of the health-insurance system is what its critics predicted all along: a confusing mess that will take months to straighten out. It likely will offset some of the blame Republicans have received for trying to upend it by shutting down the government.
Obama’s decision in 2010 to keep the task within a small circle of trusted aides reflects once again an insular wariness that has marked his administration from the beginning. Time and again, he has shown a tendency not to venture out of his comfort zone. While he seems at ease in a crowd as he stumps almost constantly for his projects, that quality does not carry over in his daily, more personal activities.
Had the president better understood the mechanics of such an enormous undertaking (reforming a system that affects roughly 18 percent of the economy) and its political impact, he would have realized he needed at least nominal bipartisan support. But the legislation had squeaked through in 2010 without a single Republican vote: While most Republicans on Capitol Hill were dedicated to obstructing the Affordable Care Act from the outset, the White House made little effort to reach out to moderate GOP lawmakers.
Moreover, by turning over the writing of the ACA to Democratic leaders while he ran around the country selling the reform’s alleged benefits, Obama fed the fires of rampant partisanship that have plagued the entire process. A majority of Americans are still confused by the enormous changes; more than 2 million have received cancellation notices about their current policies, according CBS News, despite the president’s pledge that they would not.
How this will play out in the next election is for the soothsayers to predict. But there have been grumblings from embarrassed Democrats as well as the Republican conservatives who have driven the debate.
It’s reminiscent of the Kennedy years, when another inexperienced president with great plans for settling many of the nation’s problems didn’t have a clue about how to make them a reality — and refused to take advice from Lyndon Johnson, a vice president whom he despised.
None of John F. Kennedy’s grand initiatives came about until Johnson took over and guided them skillfully around the legislative pitfalls with bipartisan support. That’s especially true of the civil rights bills that have shaped the last 50 years and helped make it possible for an African-American to become president, an event too long in coming.
Much of Obama’s handling of the ACA’s adoption and implementation seems to have been driven not by practicalities but by politics, using Hillary Clinton’s failed attempts during her husband’s administration to bring about similar legislation as a cautionary tale. That earlier effort’s failure stemmed from Hillary Clinton’s decision to write the bill in the White House, using experts of her own choosing and excluding Republicans. Obama’s advisers, remembering this, convinced him to send a broad outline to Congress and let his own party fill in the details.
Well, the devil is in the details, — and there are plenty in this act of more than 2,000 pages. Whether the details will serve this president well remains to be seen.