Peter D. Feaver, an obscure former national security official in the George W. Bush administration, is quoted in today’s New York Times saying, “The echoes to the fall of 2005 are really eerie. Katrina, which is shorthand for bungled administration policy, matches to the rollout of the website.”
Based on that single statement, the lead headline in the paper is “Health Law Rollout’s Stumbles Draw Parallels to Bush’s Hurricane Response.”
Commentators have noted the analogy seems inappropriate — no one died because HealthCare.gov doesn’t work.
But there is one important sense in which the two governmental failures are, indeed, closely related: both were largely an outgrowth of conservative hostility toward government. Though Obamacare’s rollout has obviously occurred under a Democratic administration, its efforts have been resisted and intentionally sabotaged throughout by conservative politicians at all levels of government. That opposition has played a central role in undercutting the process of successfully implementing the Affordable Care Act.
Going back to Katrina, recall that the Federal Emergency Management Agency (FEMA) was widely recognized during the Clinton administration as a model of effectiveness after James Lee Witt implemented a series of reforms winning praise from senators of both parties.
But after George W. Bush became president, his campaign manager Joseph M. Allbaugh took over the agency and followed the Heritage Foundation’s playbook of devolving emergency response functions back to the states. FEMA reverted to its past as a dysfunctional outpost for unqualified political hacks, further exemplified when Michael Brown, the former commissioner of the International Arabian Horse Association, succeeded Allbaugh. Brown was almost comically clueless throughout the Katrina disaster, yet Bush famously said, “Brownie, you’re doing a heckuva job.”
That was the FEMA story, in short.
As for Obamacare, remember that it didn’t receive a single Republican vote in either the Senate or House when it was enacted.
Four conservative Supreme Court justices wanted to strike down the entire act. The fifth, Chief Justice John Roberts, allowed the law to stand, but wrote a decision creating a huge, unanticipated loophole that allowed states to opt out of expanding Medicaid to all residents earning up to 138 percent of the federal poverty level.
As it turns out so far, exactly half of the 50 states—due to the opposition of conservative governors and/or legislatures—are not expanding Medicaid as the original legislation would have required, even though the federal government would have paid almost the entire cost.
But what about the development of the HealthCare.gov website? It’s unquestionably true that the Obama administration bears responsibility for its severe problems, which the president—unlike Bush after Katina—fully accepted in his press conference yesterday.
Still, these are among the ways in which conservative opposition greatly compounded the difficulty of that job:
Fully 27 states decided against creating their own health insurance exchanges, pushing that task onto the federal government, with an additional seven states opting for a hybrid system requiring federal involvement as well. That is far more than anyone imagined when the legislation was enacted. The mistaken assumption was that state officials would want credit for running them successfully, especially since states already regulate their own health insurance markets. Indeed, the legislation provided no money for the development of a federal exchange, while including ample resources for enabling states to set up their own. Because it has only been about a year since it became apparent that the federal exchange would have to cover so many states due to the widespread conservative hostility to Obamacare, the administration had to scramble to undertake an enormously complex task with only minimal resources available.
A Washington Post investigation into what went wrong with the development of HealthCare.gov found that “the project was hampered by the White House’s sensitivity to Republican hatred of the law—sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition.” One White House official said, “You’re basically trying to build a complicated building in a war zone, because the Republicans are lobbing bombs at us.”
According to two former officials discussed in the Post article, CMS staff members struggled at “multiple meetings” during the spring of 2011 to persuade White House officials for permission to publish diagrams known as “concepts of operation,” which they believed were necessary to show states what a federal exchange would look like. The two officials said the White House was reluctant because the diagrams were complex, and they feared that the Republicans might reprise a tactic from the 1990s of then-Sen. Bob Dole (R-Kan.), who mockingly brandished intricate charts created by a task force led by first lady Hillary Clinton. In the end, one of the former officials said, the White House quashed the diagrams, telling CMS, instead, to praise early work on those state exchanges that matched the hidden federal thinking.
Because House Republicans would block efforts to provide funding for the federal exchange if that effort was conducted directly under Health and Human Services Secretary Kathleen Sebelius, the newly created Center for Consumer Information and Insurance Oversight was housed in the sprawling bureaucracy of the Centers for Medicare and Medicaid Services. The decision was thought to be essential to protect the effort from meddling by Tea Party representatives. But that move also played a central role in diffusing managerial oversight of the undertaking. As the Post reported: “It meant that the work of designing the federal health exchange—and of helping the states that wanted to build their own—became fragmented. Technical staff, for instance, were separated from those assigned to write necessary policies and regulations.”
There’s no question that the HealthCare.gov fiasco will reinforce public perceptions that government can’t do much right. But never forget that the conservative movement is deeply invested in making those perceptions reality.