Obamacare Written in Secret, Implemented in Secret
A feature article in yesterday’s New York Times profiled Obama Administration efforts to create a federal Obamacare exchange. The article explores the massive secrecy behind the federal Exchange, and contrasts the transparency requirements imposed on state-based Exchanges with the non-transparency of HHS officials creating a federal Exchange:Mr. Hash, the director of the federal Office of Health Reform, said the federal exchanges “will operate essentially in the same manner as the state-based exchanges.”
However, they differ in a significant way. States have done their work in public, but planning for the federal exchanges has been done almost entirely behind closed doors….The 2010 health care law says that if a state runs its own exchange, it must “consult with stakeholders,” including consumers and small businesses. Subsequent rules go further, requiring states to consult health care providers, insurers, agents and brokers. Kathleen Sebelius, the secretary of health and human services, has repeatedly emphasized that “states have to meet a standard of transparency and accountability.” A state exchange must have “a clearly defined governing board,” and the board must hold regular public meetings. States as diverse as California, Minnesota, Mississippi and Nevada have Web sites where they post documents laying the groundwork for exchanges. The documents include minutes of public meetings, cost estimates and information about contracts for goods and services.
By contrast, federal officials have disclosed little about their plans, are vague about the financing of the federal exchanges and have refused even to divulge the “request for proposals” circulated to advertising agencies. The federal government requires a state exchange to develop a budget, with “expected operating costs, revenues and expenditures.” States must explain how the revenue will be generated and how the exchange will address “any financial deficits.” Administration officials have not set forth a budget for the federal exchanges. They said they intended to charge “user fees” to the participating health insurance plans, but it is unclear whether the fees are subject to approval by Congress or whether insurers could pass the costs on to consumers.
Because the Obama Administration is once again using a “Do as I Say, Not as I Do” mentality with respect to transparency – imposing requirements on states that the federal government itself refuses to follow – business owners told the Times that “nobody has any idea what the federal exchange will look like.” This lack of transparency increases uncertainty for businesses, states, and individuals, which will only make the law that much less effective.
Candidate Obama said he would televise all health care negotiations on C-SPAN, but the process leading up to Obamacare was plagued with notorious backroom deals. Unfortunately, yesterday’s New York Times story highlights how, after using backroom deals to create Obamacare, the Administration is once again retreating behind closed doors to implement the 2700-page law.
Senior Policy Analyst
Joint Economic Committee
Senate Republican Staff