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The more forgiving amongst us may feel some genuine pity for Health and Human Services Secretary Kathleen Sebelius. On one hand, President Barack Obama loaded her department with the mammoth task of writing up the thousands of rules and regulations that will constitute the real weight of ObamaCare. On the other, he charged Secretary Sebelius with the even more onerous duty of convincing a (rightfully) skeptical American public that the new 2,801 page health care reform law represented a landmark achievement that would benefit all citizens. So far, this hasn't gone so well.
The law remains unpopular to this day due to failure in the realms of principle, policy, constitutionality, and public relations. This lingering unpopularity has led to serious real-world consequences for the law itself. As Joshua Withrow noted before, a stunning majority of states have refused to set up their own state "exchanges," which are the basic machinery through which ObamaCare is meant to operate.
Unless these states undergo an inexplicable change of heart, this means that Secretary Sebelius's department will now take on the added responsibility of creating a majority of the state health insurance "exchanges." In fact, her department has so far only granted "conditional approval" to seventeen proposed state "exchanges," so the number may end up even higher than twenty-seven. It goes without saying that creating just one of these exchanges is not a cheap, simple, easy, or quick process.
Remember, the clock is ticking on ObamaCare's implementation. On October 1st of this year, citizens will supposedly be able to purchase health insurance through these "exchanges," with their coverage beginning on January 1st, 2014. Secretary Sebelius, in fear of this fast-approaching implementation deadline, has graciously (read: desperately) decided to extend or even outright waive the deadline for states to set up their own "exchanges."
This isn't the first time that Secretary Sebelius has postponed this particular deadline. Originally, states were meant to submit their proposals to her department on November 16th of last year. However, well aware that a large majority of states would not meet that deadline (or had any intentions of trying), she delayed it on November 9th to December 14th while demanding that those states that did intend to create an "exchange" must submit a brief "letter of intent" along those lines by the original deadline of November 16th.
This new deadline didn't work out so well, either. On November 15th, when Secretary Sebelius finally realized that those "letters of intent" probably weren't in the mail, she ditched that idea and admitted that the letters could be sent on December 14th, as well. However, she insisted that she would make a final decision on January 1st of this year regarding which states would be allowed to create their own "exchanges." Surely, this would be the final deadline.
As you might suspect, it didn't turn out to be the final deadline. On January 14th, Secretary Sebelius admitted that she would still accept proposals from states that desired to create their own "exchanges." In fact, she will now "waive or extend the deadline" for those states. Perhaps to preserve a shred of dignity, her department claims that proposals for "partnership exchanges" between states and the federal government must still be submitted by February 15th.
It's fair to ask whether Secretary Sebelius is "kicking the can down the road" on the issue of ObamaCare implementation. Well aware that her department is ill-prepared (if not completely incapable) of taking on the gargantuan burden of creating dozens of state "exchanges" by itself, she has continually pushed back this key deadline. Now, there is no true deadline, other than the planned starting date of October 1st.
Is there still time for her department to create these "exchanges?" Not if you were to ask Dan Mendelson, president of consulting firm Avalere Health.
The Washington Post quoted Mendelson as saying that, "It would be very hard at this point to start from scratch. I’m not going to say it’s impossible, but it would be unlikely." To be fair, he was discussing recalcitrant states and not the Department of Health and Human Services, but that only makes it worse. A state only needs to construct a single exchange. Secretary Sebelius will have to build dozens. Also, keep in mind that Mr. Mendelson provided this opinion months ago on November 9th. The situation has only grown more dire for Secretary Sebelius since then, as so much precious time has elapsed.
Secretary Sebelius has a hard job. However, she is engaging in pure self-delusion if she believes that repeatedly pushing back these deadlines will cause the states resisting ObamaCare to flock under its banner in these final months. The longer she holds out baseless hope along these lines, the less time her department will have to slap together a pile of last-minute "exchanges."
As FreedomWorks’ Vice President of Health Care Policy Dean Clancy put it, "The wheels are coming off the bus, and the Administration is getting desperate." It's time for Secretary Sebelius to admit the obvious: a majority of states in the Union do not support ObamaCare and do not want to participate in it.
It's that simple.