December 26, 2013; New York Times
Amidst all the brickbats being thrown at the Affordable Care Act by the legion of Republican naysayers in Congress aiming to undermine at any cost the progress of national health insurance reform, the Obama administration’s own problems of implementation cannot be understated. Abby Grosslein, a VISTA participant in New Orleans, observed, “It’s as if the right hand does not know what the left hand is doing,” and for good reason. AmeriCorps VISTA workers have been told that the government-provided health insurance they receive is inadequate under the standards of the Affordable Care Act and may open these terribly low-wage workers to financial penalties.
The AmeriCorps Health Care Benefits Plan, according to a bulletin from Mary Strasser, the director of AmeriCorps VISTA, “does not satisfy the individual responsibility requirement of the Affordable Care Act.” Unless VISTA workers obtain additional coverage or somehow get an exemption, they could be subject to a penalty. Because VISTA workers are not government employees (AmeriCorps workers are “stipended volunteers”), the government is not obliged to provide them with the “minimum essential coverage” they might need to comply with the individual mandate, and Strasser affirmed that the program has no plans to modify the AmeriCorps Health Care Benefits Plan to make it ACA-compliant. One of the elements of noncompliance? The AmeriCorps plan doesn’t provide coverage for treatment of pre-existing conditions—one of the biggest selling points of the ACA overall—nor for some kinds of specialty care.
Grosslein is understandably nonplussed by the news. “It would be nice if the government waived the penalty because we are a federally funded program,” said the third-year VISTA worker. “The Affordable Care Act has been on the books since 2010. Why are we hearing only now that our health plan is not compliant?” Grosslein’s frustration is shared by Sarah Sklaw, a VISTA member from New York City, who added, “It was surprising and frustrating to be told that our health coverage would not meet the law’s standards, especially because the Corporation for National and Community Service told us at orientation in August that we did not need to worry about the issue.”
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Like the unfurling of healthcare.gov before it was ready to be fully operational, like the unbelievably late distribution of grants to nonprofit navigators to help consumers find insurance on the exchanges, and like the confusing and contradictory information just recently issued by HHS on whether nonprofits can help people pay their premiums, this is one more example of the Obama administration not having its act quite together to translate the Affordable Care Act from critically important policy to competently implemented program.
If the Republicans weren’t so recalcitrant, the administration and its congressional supporters might have gone ahead with a technical corrections bill to work through some of the problems in the drafting of the ACA, but that’s an impossibility with Republicans all but signing loyalty oaths in blood to undo and repeal national health insurance reform. With Republicans trying to make every step of implementation of the program tortuous, as is evidenced by the investigations by Congress of the navigators announced almost at the same time they got their grant awards, the Obama administration has had to spend an inordinate amount of time and energy fending off attacks rather than focusing on competent implementation.
But that doesn’t excuse some obvious areas where the administration on its own accord simply fell short of competent implementation of the program. Ultimately, with the problems of healthcare.gov being worked out and now over 2 million people signed up, the Affordable Care Act will slog through to the point of providing better and hopefully more affordable health insurance coverage for millions of currently underinsured and uninsured Americans.
However, in the balance of the implementation of the ACA is the reputation of government being able to deliver on its promises and programs in a competent, professional manner. The narrative being knitted by opponents is that government inherently can’t deliver, that it screws up, that big issues—like health insurance—are best left to the private sector with minimal or no government intervention or involvement.
Let’s propose the following: As the ACA develops a reasonable head of steam in 2014 and the story shifts from “glitches” to coverage, it would be incumbent on the Obama administration on its own volition to take a hard look at where and how implementation got screwed up above and beyond the disruptive efforts of opposition legislators. There are plenty of professional, hardworking, and exceptionally competent government employees whose reputations do not need to be tarnished by the shortcomings of the Obamacare rollout. Like a competent private enterprise CEO, or better, like a competent nonprofit sector leader, President Obama should look back on this past year’s worth of healthcare insurance crises, figure out where the problems were within the administration, and weed out the directors and managers who weren’t up to the job.—Rick Cohen