Implementing ObamaCare Will Be Very, Very Difficult, Part Infinity


Politico reports that even health bureaucrats in California are worried about their ability to implement the state-based parts of the new health care law: 

California Health and Human Services Secretary Kim Belshe tells us one of her biggest challenges implementing reform is stopping her staff from getting poached. "It's a very competitive marketplace," Belshe lamented to PULSE this week. "We're competing with consulting firms to keep the people who know how to implement health reform," noting that private competitors are eyeing state Medicaid directors. In a panel Tuesday, Belshe called the situation a "train wreck" and expanded in an interview, critiquing the Obama administration's "potential disconnect between what HHS has asked states to do and what we can handle internally." 

This short passage suggests a couple of things. First, ObamaCare's state-side implementation is going to be very difficult and very complex. Even big, liberal states like California are going to have trouble keeping up with the law's requirements. Second, that complexity is going to set up a system that's 1) going to create a lot more interdependence between the government and the private sector and 2) begging to be gamed. That's presumably why private firms, especially in the consulting sector, are already investing heavily in staff who can explain what the government's doing and, presumably, how to take advantage of it. We already see a lot of this sort of thing at the federal level, with government workers taking advantage of their inside knowledge by cashing out and going to work for lobbying firms. And of course it also can't hurt to have a former insider working for you when lobbying for highly politicized regulatory waivers — a growing part of the way both businesses and unions are responding to the law. 

NEXT: Please Do Not Call This Government-Run Health Insurance Plan A Government-Run Health Insurance Plan

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  1. Better title: No One Could Have Predicted This Before We Passed ObamaCare, Part Infinity

    1. Of course no one could have predicted it, not even the Lord G– Himself (Herself?). We have The Pelosi’s insightful insight on the matter: We have to pass the bill in order to find out what is in it. (Or words to that effect)

  2. You cursed brats! Look what you’ve done! I’m melting! Melting! Oh, what a world! What a world! Who would have thought a good little state like you could destroy my beautiful wickedness?

    1. Just awesome.

  3. we are still talking about obamacare?…or about obama for that matter?…can we just give up on him already?


  4. No worries. When I hit 50 I will implement my “age backward” plan and I’ll just get healthier and healthier. There’s some detail to work out, yeah, but after I bounce off age 0 and come back to 50 again, we’ll have all sorts of cool cyborg bodies to choose from.

    Why, I’ll be able to stop being some dumpy, smelly guy and become a hot blonde babe, for example!

    (QD zones out and queitly hums to himself)

    1. If I was a chick I would be totally gay.

      1. No homo. No, homo.

  5. We’re competing with consulting firms to keep the people who know how to implement health reform.

    Like anybody, especially MA staff, has any idea how to implement health reform.

    Since about 90% of what ObamaCare calls for will be specified in regulations that haven’t been written yet, I think its safe to say no one even really knows what to implement, much less how to implement it.

    1. This. And expect future regs to require the *implementers* *prove* that they (the implementers) are acting in accordance with the law.

  6. Belshe called the situation a “train wreck” …, critiquing the Obama administration’s “potential disconnect between what HHS has asked states to do and what we can handle internally.”

    We will not stand idly by as State Health and Human Services Secretaries blame their implementation difficulties on the requirement that they provide consumers with basic protections.

  7. Who could have predicted that a 2000+ page bill that no one read would be difficult to implement?? Absolutely shocking…

  8. Yeah, yeah. There is an easy progressive fix for all of these so-called problems ….. more money! You know, like education.

    1. I gotta tell you… I don’t mind paying more in taxes when I see how effectively and efficiently the government spends my money to make the world a better place.

      1. I finger my own bu’hole and giggle when I think about the improvement of my middle class existence when “the rich pay their fair share.”

        Republicans suck, but liberals are just sick.

  9. Now why would someone who works for the State of California go to work for a consulting firm, when the state promises such excellent pensions?

  10. The implementation part may be tricky for the government, but it sure as hell doesn’t seem so hard for my insurance carrier. They have DOUBLED my premiums through our work place provider. Everyone at work is paying twice as much this year for premiums for essentially the same services. I had to switch to the HSA option instead of the PPO because it’s a little cheaper, but I hope I don’t get very sick or I’m screwed.


    1. If you get very sick, the HSA might be a better deal, but almost certainly won’t be worse.

      HSAs have a high deductible, but for a six-figure encounter with the medical establishment, the deductible is chump change, and the copays and stoploss are where its at.

      HSAs generally have lower copays, so that works in your favor, and the stoploss is usually the same. For a big-time encounter with the billing department, the stoploss is all that really matters.

      1. The big thing that I liked about the HSA’s was the pre-taxed contributions to my account that I can use for prescriptions, office visits, etc. that my company will contribute to as well. This gives me the ability to build up the account for future expenditures as long as I don’t use it, and it rolls over in to the next year.

        But you are right about the major catastrophes, it really doesn’t matter in the long run which one I choose when it comes to six figure-plus expenses.

        What kills me is just how much the rates went up this year, it’s insane. I’m not kidding when I say that the premiums for PPO literally DOUBLED.

        Whatever the hell was in that Healthcare bill has not extended any benefit to any of us who already had health insurance.

        1. it’s the medical loss ratio, elimination of lifetime caps, guaranteed issue, “free” preventive care (prohibition from requiring co-pays for all preventative services). Insurers are going to be taking on people who need health care, not insurance against an unknown or unforeseeable risk. And with the uncertainty surrounding the mandate, they need to stockpile cash now so when they have to pay out for a train-wreck of a patient in 2014.

  11. Consumers are interacting smarter in today’s health care environment –

    interesting video from Mary Kate Scott, a leader in understanding the issues and opportunities facing the health-care industry.

    video –> http://bit.ly/ConsumersGetSmarter


  12. Yeah, I was just wondering if I can start a captive company and form an ERISA plan with minimal funding to satisfy the mandate. I just have to deposit $1,000 as a surtey bond right?

    Anyway, I’d pay a consultant a couple hundred to figure this out rather than spend all weekend reading the law.

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