Health and Human Services Secretary Kathleen Sebelius has not had a very good week. Just days after the glitch-filled roll-out of the Affordable Care Act's online health insurance exchanges, Sebelius got grilled by Jon Stewart of the Daily Show. So it should come as no surprise that CNBC resident right-wing water carrier Lawrence Kudlow called for Sebelius to be fired, while CNN conventional wisdom regurgitator Wolf Blitzer coughed up this GOP talking point:
"If they had three years to get this ready, if they weren't fully ready, they should accept the advice Republicans are giving them, delay it for a year, get it to work there are health insurance sites that work great."Of course, Obamacare's critics pretend to forget that the launch of President Bush's Medicare Part D prescription drug program was such a fiasco John Boehner himself deemed it "horrendous." And as it turns out, after almost three years in the making the now very popular Medicare Rx benefit was far more despised at this point in its launch than Obamacare is now.
As Americans should recall, the Bush administration rollout of the Medicare drug benefit for 43 million elderly Americans was a disaster. Ohio Congressman John Boehner admitted as much to Fox News in February 2006:
"The implementation of the Medicare plan has been horrendous."As Ezra Klein recently recounted, in a rare moment of candor the future Speaker was right:
In 2006, the bill went into effect. It was a disaster. Computer systems didn't communicate with one another. Seniors were confused. Some of the poorest and sickest enrollees -- "dual eligibles" who qualify for aid under both Medicare and Medicaid -- weren't able to get their drugs. It was so bad that in his 2006 State of the Union address, Bush "said nothing about the new Medicare prescription drug program, an initiative Republicans once hoped to trumpet but has angered many seniors in its implementation," reported the Washington Post.As the Washington Post reported in January 2006, "Two weeks into the new Medicare prescription drug program, many of the nation's sickest and poorest elderly and disabled people are being turned away or overcharged at pharmacies, prompting more than a dozen states to declare health emergencies and pay for their life-saving medicines." Roughly 6.4 million seniors who just days earlier had gotten their prescriptions for free faced the prospect of going without because of untrained pharmacists and computer glitches. By January 16th, 2006, the New York Times reported, many states (most of them led by Democrats) came to their rescue:
About 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program.Among the governors taking action were future Obamacare foes Tim Pawlenty and Mike Huckabee, who declared a health emergency in his state of Arkansas. The fiasco prompted the Bush administration to take drastic measures:
With tens of thousands of people unable to get medicines promised by Medicare, the Bush administration has told insurers that they must provide a 30-day supply of any drug that a beneficiary was previously taking, and it said that poor people must not be charged more than $5 for a covered drug.It's no wonder why Paul Krugman summed up the whole catastrophe as "D for Debacle."
The headlines in late 2005 and early 2006 tell the tale. The launch of the enrollment period for 43 million seniors to use their new drug benefit to purchase prescription coverage from private insurers was met with stories like "Medicare prescription drug plan stump seniors" (USA Today), "Officials' pitch for drug plan meets skeptics" (New York Times), "Medicare drug plan still not generating much enthusiasm" and "majority of Americans say drug plan is not working" (Gallup). AS Kliff explained earlier this year, "Part D was less popular than Obamacare when it launched":
Eight years ago, the federal government rolled out Medicare Part D, a prescription drug benefit. For the first time ever, Medicare was launching a benefit administered exclusively through private health insurance plans. The benefit was not popular: In the spring of 2005, when enrollment efforts ramped up, polls showed Medicare Part D to be less popular than the Affordable Care Act. Fewer Americans felt they understood how it worked, too...Looking back on it, the public's turnaround from initial rejection to growing support for Part D was understandable. The unfunded $400 billion program that President Bush signed into law in December 2003 was needlessly complex for seniors and unnecessarily expensive for taxpayers. Rather than having the government negotiate prices directly with pharmaceutical firms and add drug coverage into the traditional Medicare program, President Bush and his Republican allies in Congress instead gave recipients subsidies to purchase plans from private insurers. Making matters worse, millions of "dual eligible" already receiving drug coverage from Medicaid had to switch to the new scheme, a process that left millions unable to pay for their prescriptions for weeks in early 2006.
Neither was especially popular in the months prior to their launch. Part D was even less liked: 21 percent of the public had a favorable opinion of the program in April 2005 compared to 35 percent in April 2013 for the Affordable Care Act.
But for tens of millions of American seniors, Part D was better than the alternative: nothing. As the Bush administration's bureaucratic bungles were ironed out over time (aided in large part by governors who stepped into provide resources, support and cash), public support increased. By October 2012, the Kaiser Family Foundation reported, "Survey finds seniors satisfied with Medicare Part D." As USA Today summed up the findings from Medicare Today last fall:
A new poll sponsored by a health care group shows that 90% of seniors are satisfied with the program known as Medicare Part D, and approval has constantly risen since the plan came on line in 2006.In June, the reliably Republican Wall Street Journal reported on the parallels between Medicare Part D then and Obamacare now. Reviewing an analysis by the Robert Wood Johnson Foundation (RWJF), the Journal explained:
"Nearly seven years later, 9 in 10 Medicare beneficiaries have prescription drug coverage," says the poll. "Satisfaction among those with Medicare Part D has grown 12 points from 78% to 90%. Most are very satisfied with their coverage and say their plan offers excellent value, reasonable costs, and convenience."
- Polls ahead of the Part D launch showed that more people felt unfavorably about it than liked it.Alas, it is on that last point where the paths of Part D and Obamacare diverge. Unlike Democrats then, Republican officials at all level are trying to sabotage a health care reform designed to help millions of Americans. What was unthinkable for Democrats, NBC observed in July, is now standard operating procedure for Republicans:
- There were big questions about whether enough insurers would participate.
- Everyone was worried that the IT systems and plan reviews wouldn't be ready on time.
- Pricing was a big worry.
- States were grumbling about the regulatory and cost burdens they would face under the part D program.
- The publicity campaign was daunting and consumers were confused by the options available to them.
RWJF concludes: "Past efforts to design and launch a large national health coverage program suggest that the experience will be far from perfect, at least at the outset. However, the Medicare Part D experience teaches us that, when things went awry, federal and state officials were often able to identify problems and work with stakeholders to develop policy and operational solutions, so that consumers could obtain the promised benefits."
Here's a thought exercise on this summer morning: Imagine that after the controversial Medicare prescription-drug legislation was passed into law in 2003, Democrats did everything they could to thwart one of George W. Bush's top domestic achievements. They launched Senate filibusters to block essential HHS appointees from administering the law; they warned the sports and entertainment industries from participating in any public service announcements to help seniors understand how the law works; and, after taking control of the House of Representatives in 2007, they used the power of the purse to prohibit any more federal funds from being used to implement the law. As it turns out, none of that happened.Ironically, Republican efforts to undermine Obamacare will hurt red state residents most, a realization that has prompted Republican governors in Michigan and Pennsylvania to join the list of those accepting the expansion of Medicaid. And as more and more red state residents come to grips with the greater health care access, greater insurance options and lower premiums available to their blue state family and friends, Obamacare will grow in popularity.
Just like Medicare Part D.