Love it or hate it, the Affordable Care Act is the law of the land. Passing a law is one thing, however.
Putting it into effect is another.
That's where the Obama administration is taking heat. But not from the law's usual opponents.
In sharply questioning how the administration is handling implementation of the law designed to expand health care coverage to millions of Americans, Montana Sen. Max Baucus said flatly: “I just see a huge train wreck coming down.”
Why is this significant?
Baucus is a Democrat. Baucus voted for the law. Indeed, Baucus was one of its leading authors.
During a budget hearing this week, Baucus challenged Health and Human Services Secretary Kathleen Sebelius over the law's rollout and the widespread public confusion about it.
Baucus joined others on Capitol Hill, including Democrats, in raising concerns that include:
>> Health insurance exchanges. These “marketplaces” are supposed to be created so that individuals and small businesses can shop for health insurance policies. Baucus said he is “very concerned” that these exchanges will not open on schedule. The senator's concerns are echoed by some health industry executives, who have said they don't believe the marketplaces — to be operated by the federal government and/or the states — will be ready on time.
>> Public confusion. The open enrollment period is to begin Oct. 1, but Baucus said he's worried that this critical piece of the law will fail because people lack basic information. Baucus said people need to know how the exchanges will work and how to enroll, but, “The administration's public information campaign on the benefits of the Affordable Care Act deserves a failing grade.”
He also said many small-business owners “have no idea what to expect,” and he wondered how federal officials are gauging public understanding of the law. “You need data,” he told Sebelius. “Do you have any data? You've never given me data.”
>> Delay. Another Democrat, Sen. Mary Landrieu of Louisiana, has criticized a one-year delay in a key program to help small businesses. That program would have allowed smaller employers in most states to choose from multiple policies. But in many states, only one plan will be available until 2015. That delay, Landrieu told the New York Times, will “prolong and exacerbate health care costs that are crippling 29 million small businesses.”
>> Unexpected costs. HHS said in budget documents that it expects to spend $4.4 billion by year's end on grants to help states set up insurance exchanges. That's more than twice its cost estimate of $2 billion from last year.
Responding to Baucus, Sebelius said Republicans in Congress had blocked some of the funding needed and that she has had to shift other HHS funds. She also pledged that, “We are on track to fully implement marketplaces in January 2014 and to be open for open enrollment.”
This law has been controversial and complicated since it first was proposed.
One indication of that is how many more states than expected declined to establish their own insurance exchanges, opting instead to let the federal government handle it. And two months ago, the Congressional Budget Office estimated the health care law will cost taxpayers about $1.3 trillion over the next 10 years.
It has been more than three years since the law was enacted by Congress. To continue to have this level of confusion is troubling.
With the Oct. 1 deadline fast approaching, it is incumbent on federal officials to make certain the law works. They need to manage this implementation smoothly and provide enough information so Americans can know what the health care law does, how it works and what it will cost them.