Even some of its strongest supporters now say that the federal Affordable Care Act, known as Obamacare, is going to be a train wreck. The question is, what are we going to do about it?
According to the nonpartisan Congressional Budget Office, cost estimates for Obamacare's new entitlements — the Medicaid expansion and exchange subsidies — have doubled since it was signed into law in 2010.
The CBO originally estimated the cost at $898 billion from 2010 to 2019, but this estimate included only six years of spending, since most of the provisions didn't take effect until 2014.
In the CBO's latest estimate — the first to encompass 10 full years of spending — the price tag has doubled to $1.85 trillion.
But the costs will likely be even higher.
Cost-cutting measures such as a 25 percent reduction in reimbursements for physicians who treat Medicare patients are unlikely to happen. For each of the last 10 years, Congress has declined to make those cuts for fear it will drive doctors out of the Medicare program.
Similarly, there is doubt that, when push comes to shove, Congress will approve the more than $700 billion in Medicare cuts over 10 years called for in Obamacare.
In addition, the CBO has now increased its estimate of the number of Americans who will lose their employer-sponsored health coverage as a result of Obamacare. Six months ago, the CBO estimated that four million people would lose coverage. Now that figure has ballooned to seven million. And employers are now projected to pay $130 billion in penalties over 10 years.
As the 2014 deadline for implementing the majority of the law looms, some of Obamacare's strongest supporters are expressing fears of chaos.
A recent Kaiser Family Foundation poll found that 42 percent of Americans aren't even aware the law is still in place, and there is widespread confusion about its provisions. Forty percent of respondents oppose the law, while 35 percent support it — its second-lowest rating in two years.
Enrollment in the health care law's insurance exchanges for each state is slated to begin in October for coverage that begins in January. But the federal government has not yet established health exchanges in the states that declined to set up their own, and administration officials are vague about how they will address confusion about the law.
Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee and a key architect of the health care reform law, said, "I just see a huge train wreck coming down."
At a recent Congressional hearing, Baucus grilled Health and Human Services Sec. Kathleen Sebelius on how the administration is tracking awareness of the law. "You need data. Do you have any data? You've never given me data. You only give me concepts, frankly," he said.
Senate Majority Leader Harry Reid, D-Nev., agrees with Baucus that the Affordable Care Act could be a "train wreck" if not implemented properly.
Sen. Reid's answer is for Congress to appropriate more money so the administration can properly explain and implement Obamacare. But the law has been in place for three years, and one wonders if more money at this point will help, with implementation just a few months away.
Perhaps the problem isn't that the administration has done a bad job of explaining Obamacare. Perhaps it's just a bad law.
Our nation is drowning under almost $17 trillion in debt, a burden that increases $3.82 billion each day. If the debt were called tomorrow, each of us would owe $53,400. We cannot afford a massive new entitlement plagued by runaway costs, destructive disruptions and widespread confusion.
Obamacare is a train wreck about to happen. The question is, what are we going to do about it?
Don Brunell is president of the Association of Washington Business, Washington state's chamber of commerce.