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On the Third Hand: Small stuff

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One huge, chronic problem with the House Republicans’ scorched-earth war against the Patient Protection and Affordable Care Act (PPACA) is that they’ve never given the implementers the flexibility needed to get any big new program up and running.

If Republicans saw that there was some obvious flaw in the PPACA provisions that apply to the public exchange system or the commercial health insurance market, and Democrats in the Obama administration saw the exact same flaws, usually, all the Obama administrations could do is to try to regulate away the flaws. Or, if that was not possible, to just forge ahead with a stupid law in place and hope for the best.

Now, Republicans and the Obama administration are engaged in a legitimate fight over how much flexibility Congress should give the PPACA risk corridors programs, which was supposed to collect cash from thriving exchange plan issuers and use it to help stabilize struggling issuers in 2014, 2015 and 2016. And, has to date, not collected much cash from thriving exchange plan issuers.

On the one hand: It seems as if Republicans could make a reasonable argument that increasing risk corridors program flexibility will not actually stabilize the exchanges or the individual health insurance market and will be a waste of money.

On the other hand, Medicare programs that Republicans like have had similar types of stabilization programs in place for years, and Republicans aren’t going around rampaging against those programs. Republicans seem only to hate the versions of “insurer bailout” programs linked to Obama, not the versions linked to President Bush. And insurers could make an argument that it’s mean for the government to promise, or appear to promise, access to financial support for a new project, then yank away the financial support.

On the third hand, I think that, purely on the level of how these conflicts look, not on pragmatic or moral principles, the Obama administration wins these arguments by default.

House Republicans have been so petty that they scared the U.S. Department of Health and Human Services (HHS) into hiding the division that runs PPACA commercial health insurance programs, the Center for Consumer Information & Insurance Oversight (CCIIO), inside the Centers for Medicare & Medicaid Services (CMS), rather than operating it as a stand-alone agency that Republican budget cutters could kill.

See also: HHS Overhauls Consumer Office

The U.S. Treasury Department gets to administer PPACA tax provisions through the Internal Revenue Service (IRS).

The U.S. Department of Labor gets to administer PPACA employee benefits provisions through the Employee Benefits Security Administration (EBSA).

HHS usually has to do any official task related to PPACA under its own name or under the name of CMS. Whenever, for example, it develops draft regulations, the headers in the Federal Register show that the developing agencies are the IRS, EBSA and… HHS. If CCIIO even gets a mention, it’s in a list of regulation contact people.

At this point, CCIIO’s continued inability to operate with a normal level of recognition implies that the House Republicans responsible for that situation just want to use PPACA to harass the Obama administration. Whether CCIIO should exist or not, it exists. Why does it have to be part of CMS for the sake of being part of CMS?

It’s hard to trust the Obama administration officials who’ve spent years issuing cheery statements about the great PPACA World if they’re to come up with realistic proposals for improving PPACA World, but it’s also hard to trust whatever individuals in the House Republican caucus decided that bullying HHS into hiding CCIIO inside CMS was good public policy.

It would be great if the people who shape the next round of health reform efforts could show that they really wanted to help people and make the health finance system work more efficiently, not just score (and defend against the scoring) of political points.

See also: What will replace PPACA 1.0?


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