It is clear to everyone by now that the Obamacare website is a technical nightmare. It is also an insurance disaster forcing the cancellation of plans people would prefer to keep. It is a financial disaster raising premiums for millions of Americans. It will become an economic disaster because of its hope that individuals will irrationally choose to pay far more for insurance that they don't need, or buy expensive insurance vs. pay a small "tax." It won't work.
The unintended consequences are emerging as well, but like all massive federal programs, the worst is surely yet to come. There are growing concerns about a shortage of physicians in the coming years, which could mean that despite expanded insurance coverage, access to good doctors will be limited. No government mandate can produce tens of thousands of new doctors, but government mandates surely can drive good doctors to other professions or early retirement.
Expanded Medicaid is the next Obamacare Pandora's box that Senate Republicans should be very wary of. Federal rules on existing Medicaid make it virtually impossible for any state to opt out of the current program. That is why the Democrats, when they wrote the Obamacare legislation, tried to use the threat of terminating traditional Medicaid as the "stick" to force every state to expand Medicaid. The Supreme Court, in one its few sensible rulings on Obamacare, threw out that overreaching penalty and threw the expansion debates to the individual states.
However, nobody seems to be talking about how expanded Medicaid will be viewed by the federal government once it is in place. If New Hampshire opts in, will the expanded pool just be added to the existing pool and be considered the same, or will each of the two pools (traditional and expanded) be looked at separately? The problem is that no one knows the answer to this question, nor how the courts will rule on the matter. While Senate Republicans want to hope that by enacting language to sunset our participation we can exit the program at a later date, they have no idea whether they will be allowed to leave. History should provide them with warning signs that attempts to exit the program will be opposed via regulatory fights, financial threats, and in the courts. Like Pandora, they may not be able to put all the evils back in the box.
What should they do? Senate Republicans should defer. There is nothing in the legislation that has a deadline to decide whether to expand Medicaid. This provides New Hampshire the opportunity to observe and learn as other states take the plunge and attempt to make this part of Obamacare work. If the current mess is any indication, expanded Medicaid will further erode the private insurance market, cost far more than expected and not live up to the expectations. And should it go poorly, New Hampshire can see if other states try to sunset or opt out of future participation. It is at that point we can better understand whether the federal bureaucrats will acknowledge the problems and willingly allow states to leave the program, or whether they are going to fight the states tooth and nail and make expanded Medicaid the "Roach Motel" of health programs — you can check in, but you will never check out. My money is on door number two.
Given the last two months, Republicans should embrace the opportunity to talk about the Obamacare fiasco. Obamacare is ruining families' lives through its mandates. Obamacare is limiting access to health care in New Hampshire through the imposition of narrow networks. Obamacare is driving physicians out of business. Obamacare is driving up insurance premiums because of its failed economic model. Obamacare is destroying our health care industry. These are the issues Republicans will run on when the topic turns to health care.
Offering a bad plan is a bad option politically. This is not a question of "making the perfect the enemy of the good." This is really a case of Republicans offering an awful plan as an alternative to a disaster.
There is a third option. A smarter option. An option that reflects thoughtful, good governing. Half the states are not moving forward with expanded Medicaid at this time. New Hampshire should move to the sidelines instead of lashing its future to the Titanic that is Obamacare.
Michael Sununu of Newfields is a managing director of Sununu Enterprises LLC.