Health Care and Election Timelines

by Bruce Webb

Both sides of the Health Care debate are looking and or calculating at the effects on future elections, will including a public option play in Peoria? This I think is to misunderstand the timelines because for most people the initial passage of reform really doesn’t change anything for the next two election cycles either for better or for worse. Now it may change some future expectations about what will or will not be possible after the real Day 1 of Year 1 (as defined in the bill) but not much before. Let’s review the putative timeline.

Let’s assume the Health Care bill passes this year with a Public Option and an effective date of Jan 1, 2010. What happens?

Jan 2010. Obama nominates a Health Choices Commissioner who chances are is going to be a technocrat whose name nobody outside health care wonkery will even recognize. The name goes to the Senate and is sent to Committee. (Snooze)

Jan to Mar 2010. Obama tasked with appointing members of the Health Benefits Advisory Committee with representatives of all stakeholders. (More napping by public)

Mar to Dec 2010. HBA Comm meets to hammer out the details of the Essential Benefits Package. Since the broader outlines are firmly set in the bill the only chances for something dramatic will revolve around provisions about abortion. For everyone not obsessed by Pro-Life issues not much to seize on.

Jan 2011. HBA Comm delivers recommendation to now confirmed Health Choices Commissioner. Public opens eyes and realizes that the 2010 mid-terms came and went.

June 2011. Deadline for the Commissioner to get guidelines through comment and publication requirements. Ho-hum.

July 2011 to Dec 2012. Contract negotiation between insurance companies and the Commissioner, near the end of this period private companies and the public option are marketing their plans but not actually having them in effect.

Jan 2013. Insurance Exchange opens it doors and individuals and employers start exercising options. Hey wait, we already had the Presidential election!

But through this whole process nothing really changes for anyone. If you have good insurance you will have it, if you have crappy insurance you will have that, if you don’t have insurance you will still be out of luck though maybe counting the days and saving the pennies so you can buy into an Exchange elgible plan. What I don’t see is any galvanizing event for voters. In this scenario the details of the plan will be old-hat by Nov 2010 and nobody will have been forced into anything. And this is pretty much still true by Nov. 2012, any dire change due to the plan will still be theoretical. So why should Congressmen be scared about constituent reaction? Do they really believe people will continue to be stirred up by a done deal? Right now people are being agitated or getting agitated by something quite unknown to them. Once it is in the form of legislation signed by the President and in the hands of appointed bureaucrats I see all the steam leaking out of the boiler. It’s not like the Death Panels convene the day after Obama signs the bill.