At a congressional hearing yesterday with Gary Cohen, the Health and Human Services official charged with managing the implementation of Obamacare, Republican legislators charged that Cohen's agency may be improperly allowing some states to run "assister" programs that pay people to help individuals sign up for the health law's coverage options. Republicans charged that HHS may not have the statutory authority to fund those programs in states running their own exchanges. That includes states like California, which plans to use a significant part of the $910 million it has received so far in federal implementation grants to pay 21,000 such assisters $58 for each person successfully enrolled in new Obamacare coverage.
To most observers, this probably looked like a strictly technical dispute over the rules governing Obamacare's implementation funding. But at the heart of the dispute is something much larger—the growing liberal concern over what might be called the Obamacare Nightmare Scenario: that too few people, who are too sick, will sign up for coverage under the law, that premiums will rise in the exchanges, and that this will reinforce public skepticism of the law as an unworkable burden whose primary effect is to cause costs to rise.