Insurance lobbyists are trying to shape regulations that will define “unreasonable” premium increases and require them to pay rebates to consumers if the companies do not spend enough on patient care.
For their part, consumer groups say they worry that their legislative victories could be undone or undercut by the rules being written by the federal government and the states.
The health care overhaul provides a classic example of how the impact of a law depends on regulations needed to interpret it. The rules deal with relatively technical questions but go to the heart of the law, pushed through Congress by President Obama and Democratic leaders with no Republican support.
I'm relatively confident that President Obama and Health and Human Services Secretary Kathleen Sebelius will work hard to implement the regulations. Not only do they believe in the law but they are personally and politically invested in trying to make it work—no matter how inherently flawed it is.
The bigger issue is, will whichever Republican replaces Obama as President be nearly as dedicated to tough enforcement of “Obamacare”? Republicans have a pathological aversion to regulation, and a private healthcare system is only as good as its enforcement.
Watching the unfolding BP oil-spill disaster is an example of how protection laws become worthless, depending on who’s in the White House. The Bush Administration was very close to the oil companies and appointed individuals to Mineral Management Service who had no desire to enforce regulations. The MMS let offshore oil-drilling operators take a pass on oversight.
The result is a giant blob of oil destroying one of America's best fisheries. State governments also play a role, when enforcement is left to that level.
Implementation of the health care law doesn’t start until 2014, so that could be the job of a Republican President, possibly one who might even have run against it. That is not a recipe for reining in large and well-connected for-profit health insurers. Public programs like Medicare are very difficult for Republicans to eliminate, but the GOP finds systematically ignoring regulations relatively easy.