Scan­dal out­break

Sur­vival of re­form de­pends on how ad­min­is­tra­tion weathers the storm

Modern Healthcare - - OPINIONS / EDITORIALS -

Wash­ing­ton is once again in the grip of scan­dal fever. The Beng­hazi e-mails; the IRS tar­get­ing of con­ser­va­tive groups; al­le­ga­tions that HHS Sec­re­tary Kath­leen Se­be­lius shook down health­care com­pa­nies to pro­mote the in­sur­ance ex­pan­sion in the Pa­tient Pro­tec­tion and Af­ford­able Care Act: The com­pe­ti­tion is grow­ing in­tense for top billing as the scan­dal du jour.

The stakes are high. Given the Obama ad­min­is­tra­tion’s bun­gled re­sponse to the me­dia firestorm, the most press­ing po­lit­i­cal ques­tion fac­ing health­care lead­ers now is whether the roll­out of health­care re­form will be­come col­lat­eral dam­age.

There’s a re­cur­rent pat­tern to out­breaks of scan­dali­tis. The mal­ady usu­ally strikes early in the sec­ond term of a pres­i­dent who is de­spised by his po­lit­i­cal op­po­nents.

Pres­i­dent Richard Nixon and Water­gate trained an en­tire gen­er­a­tion of jour­nal­ists to be on the look­out for the next smok­ing gun that can bring down a chief ex­ec­u­tive. Ron­ald Rea­gan and Iran-Con­tra, Bill Clin­ton and Mon­ica Lewin­sky, and now Obama. Last week, House Speaker John Boehner (R-Ohio) gave new GOP con­gress­men their first chance to vote to re­peal the ACA. Can an im­peach­ment res­o­lu­tion be far be­hind?

Sub­stance rarely mat­ters in th­ese highly politi­cized im­broglios. A close read­ing of the Beng­hazi e-mails sug­gests an in­tera­gency fight be­tween the State Depart­ment and the Cen­tral In­tel­li­gence Agency led to the ad­min­is­tra­tion’s fail­ure to im­me­di­ately say that or­ga­nized ter­ror cells might have been in­volved in the at­tack on a U.S. diplo­matic out­post.

The IRS tar­get­ing Tea Party-as­so­ci­ated groups was im­me­di­ately con­demned by the pres­i­dent, and right­fully so. Yet isn’t the root cause of this ham-handed bu­reau­cratic snafu the U.S. Supreme Court’s de­ci­sion in Cit­i­zens United, which al­lows tax-ex­empt groups to raise un­lim­ited and undis­closed cash as long they don’t spend more than half on pol­i­tics? The left and right are en­gaged in a mas­sive arms race for th­ese hid- den con­tri­bu­tions. If Congress is se­ri­ous about solv­ing this prob­lem, it would im­me­di­ately pass a law clos­ing the nondis­clo­sure loop­hole.

The al­leged Se­be­lius shake­down is rooted in the Repub­li­can-led House’s re­fusal to give the Obama ad­min­is­tra­tion money to pro­mote the start-up of the ex­changes. Ef­fec­tive im­ple­men­ta­tion will re­quire a sub­stan­tial amount of pub­lic ed­u­ca­tion. A group led by Ron Pol­lack of Fam­i­lies U.S.A. launched En­roll Amer­ica to raise money to do pro­mo­tion.

In late March, Mod­ern Health­care urged health­care firms and in­sti­tu­tions to open their wal­lets for En­roll Amer­ica. Se­be­lius’ crime, ac­cord­ing to Sen. La­mar Alexan­der (R-Tenn.), was do­ing the same by go­ing di­rectly to some of the firms her depart­ment reg­u­lates. He com­pared it to Iran-Con­tra. But there’s a big dif­fer­ence. The ACA passed Congress. Se­be­lius was en­cour­ag­ing sup­port for the law. Iran-Con­tra vi­o­lated the law. The ar­chi­tects of that fund­ing scheme were sub­vert­ing the will of Congress.

The Se­be­lius brouhaha will blow over be­cause it has no sub­stance. If one re­ally wants to un­der­stand the roots of Alexan­der’s com­plaints, one need look no farther than the fact he is up for re­elec­tion in 2014 where the only se­ri­ous chal­lenge might come from a Tea Party can­di­date on the right. A lit­tle scan­dal-mon­ger­ing now is de­signed to in­oc­u­late him­self against that pos­si­bil­ity. The bur­geon­ing IRS scan­dal, on the other hand, poses a much more di­rect threat to the roll­out of re­form. The agency has nu­mer­ous roles to play in the en­force­ment of the in­di­vid­ual man­date, the dis­tri­bu­tion of tax cred­its and the im­po­si­tion of penal­ties on busi­nesses that fail to pro­vide cov­er­age. It also will col­lect taxes levied on in­sur­ers, med­i­cal de­vice man­u­fac­tur­ers and hos­pi­tals.

Last week, the pres­i­dent fired the in­terim chief of the IRS. If new act­ing com­mis­sioner Daniel Wer­fel be­comes par­a­lyzed by scan­dal, it will be much more dif­fi­cult for the IRS to meet the chal­lenges of ad­min­is­ter­ing the com­plex law. For those root­ing for its fail­ure, that’s the point.


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