I think Robert Samuelson has the correct political read on Health and Human Services secretary Kathleen Sebelius’ recent decision. The health care policy moves by the Obama administration since the 2010 election all seem to be about trying to minimize as much as possible health care reform as a political issue in the 2012 election. From Sameulson:
Sebelius ducked this question by requiring each state to define essential health benefits based on existing policies in that state. Almost no one anticipated this. The ACA does not suggest it. Sebelius asked for advice from the nonpartisan Institute of Medicine (IOM). Its report talks of a national standard for essential health benefits, although it also notes that the ACA allows the secretary to provide state-by-state waivers beginning in 2017.
Politically, Sebelius’ decision is a masterstroke. One Republican criticism of Obamacare is that it imposes a “one-size-fits-all” straightjacket on health care. Mitt Romney — the ex-governor of Massachusetts and author of that state’s universal health insurance plan — has made this point repeatedly. President Obama can now retort: “No, we’ve left crucial decisions to the states.” He can also argue that Washington isn’t dictating “how medicine should be practiced.”
I would add to this the unprecedented move by Sebelius to overrule the FDA about the emergency contraceptive Plan B and President Obama’s decision to endorse the Wyden-Brown bill to move up the start date for the state innovation waivers.
Obama’s decision to endorse the bill reeked of the same basic political calculation as this recent move by Sebelius on essential benefits. If Obama really wanted the earlier start date he could easily had it included in the original Affordable Care Act when it passed, instead he only endorsed the idea when it was clear it had no chance of becoming law.
Despite claims that Obamacare would become popular after it was passed and promises that the Democratic leadership would keep fighting hard to win the PR war over the law, it has remained very unpopular. With the law designed to not even begin trying to make good on its big promises until over a year after the 2012 election, there is just no reason to believe the law is going to get popular by the election.
It seems the Obama team has basically made the calculation that they simply can’t win on this issue so they can only try to minimize the amount the issue of health care will be talking about.