Bungling the Easy Stuff

Hospitals are still overcharging the poor. Obamacare was supposed to fix that too. What went wrong?

By Steven Brill Monday, Dec. 16, 2013
    • Evan Vucci / AP

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    Yes, Obamacare has already done landmark work in protecting the truly poor from health care costs by dramatically expanding Medicaid coverage (except in states like Texas, where Republican governors are so obsessed with sabotaging the law that they have blocked the expansion). But writing these billing regulations would have been easy, would have applied in every state and wouldn't have cost a penny.

    A scan of other relatively obscure but important provisions written into Obamacare reveals similar failures by the President and his team to execute even the easy stuff.

    Another section of Obamacare requires all hospitals to "establish (and update) and make public ... a list of the hospital's standard charges for items and services." In other words, under Obamacare, the chargemaster would finally see the light of day. But first Secretary of Health and Human Services Kathleen Sebelius and her staff had to write guidelines for how the list was to be put together.

    That, too, hasn't happened. Hospitals are still not required to list prices for consumers, although in response to TIME's "Bitter Pill" story, the Centers for Medicare and Medicaid Services did release a one-shot mass of data in May. But only someone with expertise in working with spreadsheets could extract the prices from that data. "We do not have an update on the timeline for implementation of this provision at present" was all Sebelius spokesperson Erin Shields would say about the hospital-price-list requirement.

    Lew, in consultation with Sebelius, was also supposed to issue an annual report, beginning presumably in 2011, spelling out the charity care provided by every hospital. But the charitable-giving report "has not been issued," says Treasury spokesperson Victoria Esser, who explained that Treasury is working with the Department of Health and Human Services "to identify and gather the appropriate information."

    Obamacare is the President's signature domestic achievement. It's bad enough that the design and launch of its insurance-exchange website was bungled and required emergency treatment. But at least for that there is the excuse, lame though it may be, that building this gargantuan e-commerce platform was hard.

    But that they also haven't yet delivered on the easy stuff related to the President's highest priority suggests that the Obama team was so lacking when it came to turning law into reality--better known as governing--that the website never had a chance.

    Brill, who with this issue begins a series of columns on Obamacare, is writing a book about the business and politics of health care to be published in 2014 by Random House

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