A long time to wait

A LONG TIME TO WAIT…. If things go according to plan, President Obama will sign a health care reform bill into law sometime in January. Almost immediately, a wide variety of consumer protections will kick in, including security for those with pre-existing conditions who’ve faced discrimination from insurers.

But some of the biggest elements of the plan — most notably subsidies for those who currently lack coverage — won’t get up and running until 2014 (or, in the House bill, 2013). The reform framework will endure plenty of attacks between now and then.

What’s behind the delays? Kevin Drum had a good item on this.

I’m pretty sure the 2014 date is mostly due to budget finagling. This stuff can’t be done overnight, but I’ll bet most of it could be implemented within 12 months, and it could certainly be implemented within 24.

So how big a problem is it that nothing is going to happen until 2014 instead? My first order guess is: not much. In fact, I think everyone will be surprised at just how fast healthcare reform fades from the public discourse once it’s passed…. After all, the plain fact is that as important as it is, healthcare reform affects a pretty small chunk of the population either for good (better coverage) or ill (higher taxes). Around 15-20% tops.

Still, sooner would be better. It’s easier to demagogue healthcare reform as long as the supposed disasters to come are still speculative, and it’s easier to keep around the longer it’s had to work.

Agreed. As far as I can tell, literally the only reason to delay implementation of subsidies until 2014 is to bring down the overall cost of the bill. The Senate version costs $871 billion over 10 years, which is below the ceiling the White House presented in September. Moving up the schedule means moving above the ceiling.

But that’s unsatisfying for those who see 2014 as an excessive delay. Paul Starr argues today that a faster timetable should be a priority in the conference-committee talks.

One possibility is to abandon the idea that the program has to be implemented on the same date in every state across the nation. Instead, states might be given incentives (though not yet full funding) to come into the program early, perhaps even during 2011. A state like Massachusetts, which already has a functioning insurance exchange, might be able to move that quickly. Other states might follow during 2012, with a final date for implementation and full federal funding coming in mid-2013.

Staggering the start-up dates would enable states that acted later to learn from those that moved first. By fall 2012, under this approach, President Obama and the Democrats who had voted for reform could point to areas of the country where the program was already in effect. And even if Democrats lost the 2012 election, it would be difficult to undo the program and take insurance coverage away from the millions who had gained it.

There is one final possibility. Even if the House-Senate conference adopts the slow Senate timetable, the proposal for accelerated implementation in “early-action” states could still be passed separately in a subsequent budget-reconciliation measure (which requires only 51 votes in the Senate). One way or another, Democrats need to find a way to speed up the pace of reform.