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Life Health > Health Insurance

On the Third Hand: Devil

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Bill Cassidy, a Republican, brought the 2014 elections to a rousing end on Dec. 6 by defeating Sen. Mary Landrieu, a Democrat, in a runoff race in Louisiana.

Cassidy’s victory over Landrieu means that the Republicans will have 54 seats in the Senate this year.

Some pundits are describing the Republicans’ new control over the Senate as a sign that voters hate the Patient Protection and Affordable Care Act (PPACA).

I think another way to look at the results is that voters want “transparency in government” to mean that the government should be honest with the public, not that government officials should be able to read our private cell phone messages when they’re bored.

Cassidy, a Republican had been serving in the U.S. House of Representatives since 2009.

Landrieu, a Democrat, began serving in the Senate since 1997. Since 2010, she had been trying to make peace with other Democrats over PPACA and, at the same time, show Louisiana voters that she could see PPACA’s flaws as well as its potential virtues.

That was a hard job.

As an outsider, Cassidy had the freedom to support PPACA implementation reform bills with obvious bipartisan appeal to anyone outside the Congressional Progressive Caucus. One example: H.R. 3362, a bill that would have required the U.S. Department of Health and Human Services (HHS) to post weekly, standardized PPACA public exchange activity reports.

H.R. 3362 passed in the House with unanimous support from all Republicans who voted – and with support from 33 of the 187 Democrats who voted. The bill then entered the PPACA Loyalty Zone in the Senate and died.

Over in the Senate, Landrieu struggled to get her PPACA-supporting colleagues to back bills of her own that had obvious strategic appeal.

HHS decided, for example, that PPACA forbade it from letting licensed agents and brokers who were receiving any commissions from health insurers serve as PPACA exchange navigators, or ombudsmen, even though exchanges could let people who had gotten all of their knowledge of health insurance from a short indoctrination session serve as navigators. HHS excluded the producers its exchanges did certify from the meetings it held for other types of exchange assisters.

One agent group made waves by simply e-mailing copies of the same mild-mannered HHS newsletters that were going to the exchange assisters out to the producers.

Landrieu proposed a bill that would have required HHS to set up a dedicated telephone hotline for broker enrollment policy questions and post a directory of exchange-certified agents on That bill, S. 2175, died in committee. It never even got a hearing.

Landrieu seemed to have a sincere interest in helping agents and brokers serve consumers, and in making the PPACA exchange system work as well as it could.

It looked as if she was going up against an Obama administration and Senate Democratic leaders who were pretending to share her goals but, really, wanted to put a curtain around the exchange program, to keep anyone who might understand it from seeing what was going on.

On the one hand, the Republicans may have contributed to the Democratic leaders’ lack of candor about the exchange system with their bitter opposition to implementation of any line of PPACA.

On the other hand, one of the main reasons to have an exchange system is transparency. If our government is too dysfunctional to be transparent about its exchange system, what’s the point of having an exchange system?

On the third hand, shortly before Cassidy defeated Landrieu, House Republicans got Medicare cuts through their chamber by wrapping the cuts inside a resolution few knew about.

Maybe health finance is so difficult that policymakers have to trade their candor to the Devil in exchange for getting health legislation enacted. It will be interesting to see whether the Republican leaders of the new Congress can do much related to health finance out in the open.


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