Three indications Obamacare is NOT about to fall apart

I haven’t made a secret of the fact that I am not a fan of Obamacare. I have to admit that I take a grim pleasure in the news about the administrative foul-ups that have complicated the “rollout.”

I am skeptical that any complication or delay will lead to substantive changes in the misnamed “Affordable Care Act.” Even the current tinkering with the individual mandate doesn’t make me feel much better. The Administration’s #1 concern seems to be that the public is having trouble with the web site. What happens once the web site is up and running? ACA implementation will proceed apace. Obamacare as we know it is perfectly safe. Here are three reasons I’m not breaking out the champagne over ACA glitches.

Kathleen Sebelius is still Secretary of HHS.

As long as Secretary Sebelius holds down her Health and Human Services job, we know the Administration is not having second thoughts about Obamacare. Sebelius has been the second-biggest advocate, cheerleader, and apologist for the program since the day Nancy Pelosi brought down her gavel and jubilantly announced “The bill is passed!” President Obama and Sebelius are the faces of the ACA.

If she were to leave her post during this President’s tenure, it would look as though the ACA were a dead horse she got tired of beating. If Obama were to let Sebelius go, he’d be acknowledging substantive trouble with his pet law. As long as he keeps her, he shows confidence in the legislation.

The White House is still saying birth control is “essential to women’s health care” and is still telling Americans how to practice religious beliefs.

In a White House statement issued last month after the U.S. Supreme Court agreed to take the Hobby Lobby case, the press secretary speaking for the Administration affirmed “The health care law puts women and families in control of their health care by covering vital preventive care, like cancer screenings and birth control, free of charge [emphasis added]….The Administration has already acted to ensure no church or similar religious institution will be forced to provide contraception coverage and has made a commonsense accommodation for non-profit religious organizations that object to contraception on religious grounds.  These steps protect both women’s health and religious beliefs, and seek to ensure that women and families–not their bosses or corporate CEOs–can make personal health decisions based on their needs and their budgets.”

Consumer control of health care decisions means no co-pay? I haven’t seen any comparable White House statement about how awful it is that bosses or corporate CEOs make personal health decisions for families by denying 100% coverage of diabetes regulation – which is after all preventive in a logical if not political sense, given how uncontrolled diabetes destroys health. If giving women and families full control of health decisions means not having any co-pays for birth control, how can ANY co-pay stand under law?

So suppression of fertility is still the same thing as cancer screening in the eyes of the Obama Administration. Women’s fertility, that is. Once that falsehood is abandoned by the President and a majority in Congress, Obamacare will lose one of its essential supports.

The White House continues to say that “commensense accommodation” has rendered all religious challenges to the ACA moot. More than eighty pending lawsuits say otherwise. “Religious organizations” as defined by the Administration are accommodated. Individuals holding to the same religious tenets as those organizations are not. That’s the trouble with the HHS mandate.

Republicans in Congress have not as a majority body expended political capital to challenge the mandate, and Democrats are only too happy to elevate contraception above the Constitution. That means the HHS mandate will stand, unless the Supreme Court throws it out. As long as the mandate stands, so does Obamacare.

Lack of cybersecurity hasn’t brought Obamacare to a screeching halt.

There’s no one left in a Cabinet-level Administration post who can say with a straight face that the information Americans enter into a computer in order to sign up for the ACA is secure. Privacy is not a serious consideration within the law, nor has it ever been. Once that changes, I’ll know Obamacare is in trouble – because that will mean a full stop to the law while the technical side is re-developed.

John Fund in a recent column summarized how HHS addressed security concerns in Obamacare’s early days, based on the Federal Register from March 27, 2012: “At that meeting, two commenters asked HHS to ensure the exchanges would promptly notify affected enrollees in the event of a data breach or unauthorized access to the exchange’s databases. One commenter suggested that a full investigation be launched each time such a breach occurred, with the goal of holding hackers legally and financially accountable for breaking into the website. According to a report by the group Watchdog.org, HHS responded: ‘We do not plan to include the specific notification procedures in the final rule. Consistent with this approach, we do not include specific policies for investigation of data breaches in this final rule.’ In other words, the government doesn’t have to tell you about a security breach unless it decides it wants to — despite the fact that private companies are required to publicly disclose any incidents. State laws also require many of the 14 state-run insurance exchanges to disclose such information, but no such law exists for the federally run exchange, which 36 states rely upon.”

Imagine a private company being so cavalier about data breaches. A recent breach at Target stores resulted in quick detection and immediate efforts to warn consumers. If the company had been any slower to react, Target’s CEO would be getting grilled in Washington right now, with cameras rolling and politicians thundering about the evils of Big Business. Corporate heads would roll. The same behavior in a government agency doesn’t bring forth quite the same reaction.

And by the way …

Don’t confuse ACA implementation with health care. What kind of metric have you heard of that HHS might use to measure outcomes from ACA? Will we know in five years how many people have coverage, compared to today?

Probably not. The baseline the government will use to measure coverage will probably be how many people had ACA-compliant policies before the ACA was in place. Wonderful. We’ll have a meaningless statistic that will keep us in the dark about the only health-coverage question that ought to matter to HHS: how many Americans are getting CARE? Not insurance coverage, but actual care. Not how many dollars we’re spending on Medicaid and insurance subsidies, but how many people need health care and aren’t getting it.

Will Americans be healthier in five years, or will they just be filling out different forms at their clinics?

Obamacare seems to be set up to keep that information obscured. Insurance equals care, goes the narrative, and actual care is not what we’re tracking here.

The rumors of Obamacare’s death are greatly exaggerated, it seems to me. When Sebelius is out, the HHS mandate is gone, and web site security becomes a priority, I might take a different view. Until then, regardless of controversies, Obamacare is entrenched.

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