Obamacare just got easier to implement, not harder

July 8, 2013

This hasn't been a banner news week for Obamacare. But can it really be true, as my colleague Jennifer Rubin writes, that "Everyone now agrees: Obamacare can't be implemented"?

Er, no.


These folks might love it even more now! (Mark Wilson/Getty Images)

I asked around. Peter Orszag, who helped design Obamacare from his perch as head of the Office of Management and Budget, disagreed with Rubin. "Delaying the employer mandate makes successful implementation more likely, not less likely," he told me.

Larry Levitt, vice president of the nonpartisan Kaiser Family Foundation, agreed. "There’s nothing about the delay in the employer requirement that suggests Obamacare can’t still be implemented," he said. "If anything the delay removes some potential administrative complexities from the plates of the implementers, and avoids the problem of some employers reducing the hours of part-time workers to get around the requirement."

Timothy Jost, a health law expert at Washington and Lee University's School of Law, was even blunter. "Implementation just got easier rather than harder," he said.

Well, so much for "everyone."

As those interviews indicate, the thinking among health-care experts is closer to the precise opposite of Rubin's bombastic headline: The Obama administration has decided to accept some bad media coverage now, and some higher costs later, in order to make Obamacare much, much simpler to implement next year.

There were two noteworthy changes to Obamacare in the last seven days. The first is that the employer mandate, which tells businesses with more than 50 employees to provide affordable insurance or pay a per-employee penalty, won't be enforced until 2015. The second is that people applying for low-income subsidies in the exchanges will face fewer audits in 2014.

Both changes make the same trade-off: They raise the law's first-year costs in order to reduce its first-year problems.

The poorly designed employer mandate was perhaps the most serious threat the law faced in its first year. Only about 10,000 of the economy's 5.7 million firms were expected to face the mandate, but that's still a lot of angry business owners. And while some of those business owners would respond by grudgingly offering insurance, others would respond by cutting back on hours for their employees, or even firing some of their employees.

For Obamacare, the resulting headlines would be lethal. Add in that even businesses that were already complying with the mandate would have to follow  annoying reporting requirements to prove they offered insurance and the law had a real problem among a politically powerful constituency.

Now, it doesn't. At least not until 2015, assuming the mandate actually begins then. That isn't to say the delay is costless: The federal government will lose billions in penalty revenues, and some employers who would've begun offering health care will simply let their employees drift into the individual marketplaces instead. But in terms of implementation, Obamacare just got a lot easier to implement, if a bit pricier.

The consumer-information delay is a similar story. The question here is how the insurance marketplaces verify the income and insurance status of the people who come to them looking for help. If they don't scrutinize the claims closely enough, some people who don't qualify for subsidies may receive them anyway. But if they require reams of documentation, various parts of the process can break down as computer systems prove unable to talk to each other or people struggle to come up with the required paperwork. The result would be that people who do qualify for help don't get it -- a problem that bedeviled the first year of the Medicare Prescription Drug Benefit.

On Friday, the Obama administration said that in the law's first year, they would accept the testimony of consumers when they applied for health insurance. That means that if you tell the government you make $10,000, the government simply believes you. There will be random audits, much as there are when you pay your taxes, but that's about it. In 2015, the requirements will tighten further, and the federal government can claw back subsidies that were improperly awarded.

Here, again, the calculation is simple: The Obama administration made implementation easier -- both for themselves and for the consumers -- at the cost of making the bill a bit more expensive.

Obamacare's critics appear to be enjoying something of a Pyrrhic victory right now: They get to (rightly) criticize the administration for unilaterally delaying unpopular and ill-drafted elements of the law. But they seem to be assuming that the bad media coverage now can be extrapolated into bad implementation next year.

That misses the choice the White House actually made: Bad press now, and higher costs in 2014, in return for an easier roll out. Whether you think the White House is making the right policy call will depend on whether you prefer slightly lower costs to a smoother rollout. But so far as Obamacare's implementation goes, it just got easier, not harder.

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Neil Irwin | July 8, 2013