LOS ANGELES (MarketWatch) — Though many wish it had never been born, Obamacare will reach kindergarten age as of Monday.
It was five years ago, on March 23, 2010, that President Barack Obama touched off what may end up being the most persistent and contentious national debate on record by signing the Patient Protection and Affordable Care Act into law.
From that day on, the controversial measure designed to give health coverage to as many of the nation’s roughly 50 million uninsured as possible, embarked on one of the most storied odysseys since.
It’s birth and infancy were fraught with trauma. The law was the subject of literally dozens of attempts by Republican lawmakers to repeal it, efforts that continue to this day. It narrowly survived a 2012 Supreme Court challenge and now faces extinction again before the high court’s justices over whether four simple words in the 2,000-page law are constituted to mean three-fourths of the country is ineligible for Obamacare subsidies, critical to the law’s success.
And when it came time to actually put the law into action in late 2013 — you could call it Obamacare’s first attempts at walking and talking — the initiative stumbled over numerous technological hiccups. While many of those were cured shortly after, the process still proves to be challenging from time to time, as evidenced by last week’s trouble with the mailing of erroneous tax forms relating to health-care coverage.
Everyone knows the basics of Obamacare: You now have to have health insurance or face a tax penalty; employers with 50 or more full-time workers have to cover them; subsidies are available in order to make insurance affordable. But there are several random things about health reform that either existed from the outset, or developed over the last half-decade, that may be surprising:
1. Republicans once favored an individual mandate, and Hillary Clinton was opposed to it: Long before Obamacare made it mandatory that all U.S. citizens buy health coverage, President Bill Clinton tried to pass a comprehensive health-care law of his own, shortly after he took office in 1993. The legislation included a mandate that all employers offer coverage, but there was no requirement that everyone buy insurance.
Dan Mendelson, now chief executive of consultant Avalere Health, worked in the Clinton White House as associate director for health in the Office of Management and Budget. He notes that the president — and Mrs. Clinton — who campaigned heavily for passage of the 1993 efforts, rejected the notion of individual mandates as being too right-wing. Meanwhile, history notes that Republicans tried to push through their own plan at the time that would have required individuals to buy coverage.
Over time, the two sides reversed their positions. As the individual mandate became more accepted, and worked when Massachusetts adopted its own health-care law in 2006, Democrats warmed up to the idea. Republicans, meanwhile, disdained the idea once it became part of Obamacare.
Mendelson often muses at the current debate over Obamacare, adding that such complex legislation will never be easy.
“I come at it with a healthy understanding of what it takes to implement a new benefit,” he said.
2. Don’t blame equipment for Obamacare tech issues — blame management: That’s what Sanjay Singh, chief executive for tech consultant hCentive, says. Although numerous editorial cartoons poked fun at what was perceived to be Stone Age tech gear when the federal HealthCare.gov website couldn’t get off the ground, Singh says that simply wasn’t true. The federal government isn’t afraid to spend on tech gear, he says.