“The implementation of this complicated legislation introduces almost as many challenges as passing it did–and will be just as crucial to the program’s success. However, implementation introduces a very different kind of politics largely outside the media spotlight, without the dramatic votes or tight schedules.”
Oh, man, is this a key point. A lot of people seem to assume that the health reform law marks the end, when it is much more of a beginning. Of course, you can’t fault those people, because as the quote acknowledges, the media’s coverage of health reform has all but ceased entirely. That stems from the absence of a dramatic story–there are no back-and-forths between Senators, or looming deadlines for down-to-the-wire votes. In a sense, the “sport-like” aspects of politics have ended, and with it, the public’s interest. Perhaps more accurately, it’s shifted to the upcoming mid-term elections and the idea that some Republicans are running on promises of repealing the legislation–the idea of a contest sparks public interest.
I might disagree to an extent with the idea that tight schedules are no longer. Because the legislation wasn’t amended in conference committee, there are a number of dates specified in the legislation that the Department of Health and Human Services is working around the clock to try and meet. I would not say, however, that the public is generally aware of these efforts in the way they were aware that the Senate would be voting on health reform on Christmas Eve. So perhaps that’s the point.
But the real substance of this quote is that the nature of the politics now playing out has changed. It’s no longer a debate in the public domain. Instead, the HHS staff are busy drafting rules and regulations to flesh out the broad authority contained in the law. This is a lengthy process, and one in which lobbying arms of various stakeholder groups will make comments (i.e., raise objections) about proposed regulations. This tug of war can go a long way in determining what health reform actually looks like at its implementation. But most Americans aren’t familiar with this process, and would be quickly overwhelmed by its detailed complexity. These next steps matter, but they will all take place behind the scenes.