As students our lives are often governed by deadlines. There is no option to turn in that assignment a month late because we think we’ll have a better shot at an ‘A’. We can’t wait to write that paper next semester when we’ll have more free time. And we can’t delay taking that test until after grades are handed out for fear of bringing down our average. No, in each of those scenarios we’d be laughed out of the classroom, handed a zero and be wished the best of luck in our future endeavors.
But when it comes to Obamacare the Obama Administration is missing deadlines, indeed it has already missed half of them. Avik Roy reports for Forbes:
In recent months, President Obama and his subordinates have waived or delayed a number of Obamacare’s notable features, such as the law’s employer mandate, and its procedures for protecting taxpayers from fraud and identity theft. Earlier this month, in that context, I obtained a heretofore-unpublished memorandum from the Congressional Research Service. The CRS, Congress’ non-partisan in-house think tank, compiled 82 deadlines that the Affordable Care Act mandates upon the first three years of its own implementation. Remarkably, it turns out that the White House has missed half of the deadlines legally required by the ACA. And some of those deadlines remain unmet to this day.
This report should put to bed the notion that Obamcare is failing because of Republican attempts to sabotage the law. Only 9 of the 82 deadlines were not met because of a lack of Congressional appropriation and none of them are core components of Obamacare’s larger vision. On the contrary, the deadlines that have been missed or ignored are critical to achieving Democrats’ stated ends.
One of the most important system changes Obamacare was supposed to make was moving away from “fee for service” health care towards a model that would pay based on outcomes. This is common economic sense. In a fee for service system that will pay for whatever a physician prescribes the incentives are aligned to order superfluous tests, choose the most lavish course of treatment and overprescribe medications. As you can imagine, that leads to massive overspending, even when none of the extra actions necessarily improves the health outcome of the patient.
According to the CRS, one of the Obamacare deadlines required “the HHS Secretary to develop requirements for health plans to report on their efforts to improve health outcomes, prevent hospital readmission, ensure patient safety and reduce medical errors” and also “promulgate regulations the provide criteria for determining a reimbursement structure to improve quality.” That was supposed to have been done by March 23, 2012 and yet more than a year later the best the CRS could come up with was that “no public information [could be] located.”
The CRS’ report that the Obama Administration hasn’t achieved half of its deadlines is likely conservative in its estimate. After all, it doesn’t include high profile delays like the one issued last week on the out-of-pocket costs. And it is those types of unilateral executive delays that are causing some Washington-watchers to question whether President Obama is overstepping his bounds.
The Chicago Tribune’s editorial board writes:
Democrats strong-armed Obamacare into law three years ago. Now they’re busy flouting it.
. . . The administration asserts that it can make these changes under the president’s broad executive authority. Yet critics make a compelling argument that the president is stretching the limits. Former federal appellate Judge Michael McConnell, director of the Constitutional Law Center at Stanford Law School, writes in The Wall Street Journal about a different sort of mandate: the mandate in Article II of the Constitution that the president “‘shall take Care that the Laws be faithfully executed.’ This is a duty, not a discretionary power. … As the Supreme Court wrote long ago (Kendall v. United States, 1838), allowing the president to refuse to enforce statutes ‘would be clothing the president with a power to control the legislation of Congress, and paralyze the administration of justice.'”
. . . Congressional Democrats, and some Republicans, may agree with the numerous delays, changes and special favors. But the president invites chaos when he picks which parts of Obamacare to enforce, and which, in retrospect, he has decided are unworkable or unwise.
Deadlines matter. The bill as written matters. The provisions, as passed by the House and Senate and signed by the president matter. If the Obama Administration wants to seek changes to this monstrosity of a law he should begin by delaying it for a year to give Congress time to work through the legislative process rather than continue to flout the Constitution.