Congressional Research Service: “The precise number of new entities that will ultimately be created pursuant to PPACA is currently unknowable”

By mw | Related entries in Health Care, health care reform, Missouri


This updated chart of “Your New Health Care System” got a lot of play around the right-o-sphere, and even a few lefty blogs. The chart is a partisan Republican attack on the PPACA (healthcare reform) bill that was steamrolled on a partisan Democratic vote over the loud but legislatively impotent Republican minority. But to paraphrase a favorite quote – Just because it is partisan, does not mean it’s not true. The chart has received accidental support from the non-partisan Congressional Research Service.

The CRS ReportNew Entities Created Pursuant to the Patient Protection and Affordable Care Act” is apparently intended to defuse charts like this, but actually details an even more frightening state of affairs:
“This report describes dozens of new governmental organizations or advisory bodies that are mentioned in PPACA, but does not include other types of entities that were created by the legislation (e.g., various demonstration projects, grants, trust funds, programs, systems, formulas, guidelines, risk pools, websites, ratings areas, model agreements, or protocols) …

The precise number of new entities that will ultimately be created pursuant to PPACA is currently unknowable…

The degree of specificity in these provisions may have implications for congressional control and, conversely, the amount of discretion that agencies will have in the implementation of the legislation. PPACA significantly increased the appointment responsibilities of the Comptroller General of the United States, and it is unclear how the Government Accountability Office (GAO) will be able to independently audit entities whose members are appointed by the head of GAO.”

The report was released in early July, but the MSM and blogosphere are just now beginning to pick up on what it says about our new law of the land.

Politico: Health reform’s bureaucratic spawn

“Don’t bother trying to count up the number of agencies, boards and commissions created under the new health care law. Estimating the number is “impossible,” a recent Congressional Research Service report says, and a true count “unknowable.” The reasons for the uncertainty are many, according to CRS’s Curtis W. Copeland, the author of the report “New Entities Created Pursuant to the Patient Protection and Affordable Care Act.” The provisions of the law that create the new entities vary dramatically in specificity. The law says a lot about some of them and a little about many, and merely mentions a few. Some have been authorized without any instructions on who is to appoint whom, when that might happen and who will pay.”

CNN: Cafferty File

A sprawling bureaucratic giant – nobody knows how big it will be. That seems to be the result of President Obama’s new health care law. According to Politico, a recent report says it’s “impossible” to estimate the number of agencies, boards and commissions created by the new law. The Congressional Research Service report points to many reasons for this. First off, the parts of the law that create new bodies vary drastically. In some cases – the law gives lots of details… in other cases, barely a mention. Also, the law authorizes some new entities… without saying who will do the appointing, or when it will happen. And all this means some agencies could wait indefinitely for staff and funding… while others could multiply… creating quote “an indeterminate number of new organizations.” So far this is shaping up to be exactly what the critics were afraid it would be… How will the government manage our health care if it’s “impossible” to know the number of agencies, boards and commissions created by the new health care law?”

Ed Morrisey at Hot Air: ObamaCare: The Infinite Bureaucracy Act

“CRS wanted to say that there wasn’t enough certainty in the number of agencies, panels, and committees to put them into flowcharts with connecting lines. Like Nancy Pelosi once argued, the CRS report says that we can’t know what’s in ObamaCare until the government rolls it out . That in itself is a big, big problem. It seems clear that Congress just authorized a self-perpetuating bureaucracy, one that can expand on its own and make determinations far outside of the boundaries Democrats promised during the ObamaCare debate. And if that’s true, then it is equally true that the claims made on the cost of administering ObamaCare had no real basis in fact. How can one estimate a cost for a bureaucracy that is entirely undefined in size and scope?”

Washington Examiner: Obamacare is just the beginning

“Just in case anybody missed Copeland’s point, Barbash noted that “implicit in the report is a message not to take too seriously the elaborate charts and seemingly precise numbers peddled by Republican critics that are designed to show the law’s many bureaucratic tentacles.” But folks who actually read the Copeland report and scan those two scary GOP charts are quite likely to reach the contrary conclusion. In fact, one might even think the GOP critics were being too easy on Obamacare… Copeland looked at only part of the picture. The rest of the picture — those demonstration projects, grants, trust funds, programs, systems, formulas, guidelines, risk pools, etc. — will result in at least as much, if not much more, bureaucratic expansion. So, while the precise number of new government bureaus and bureaucrats created by Obamacare can’t be known now, what is known beyond any shadow of a doubt is that there will be more, much more, government.

Some Democrats have taken comfort in a recent tracking poll indicating that opposition to Obamacare has marginally decreased. I’d put that in the same category of self-delusion as America is a center-left country”,”demographic realignment means a permanent Democratic majority, and a Republican cannot win Ted Kennedy’s seat”. This is legislation that only looks good if you blur your vision and avert your eyes. The promised deficit reduction has evaporated, the expected cost controls – don’t, and even before the most expensive benefits and costs kick-in, healthcare reform has already become an economic drag aggravating unemployment.

I expect the GOP will make sure everyone gets a good long rub-your-nose-in-it look between now and November. Every GOP candidate will be taking shots at Obamacare, and that is one slow fat rabbit to hunt. When you look at the chart and read the CRS report – the campaign ads write themselves. Since few Democratic Party candidate have any idea of what is in the hairball they voted for – well – lets see what happens when they have to keep explaining the details to the voters.

Missouri voters have taken a close look and made it clear what they think about the law. Claire McKaskill’s response to the vote illustrates the Democratic dilemma. She simultaneously acknowledges the depth and breadth of frustration with the law while trying to minimize the meaning of the vote. You can’t do both.

This administration is nothing if not sensitive to the political winds. To counteract the worsening negative perception, they’ve recruited Andy Griffith as spokesman:

Color me skeptical, but I don’t think an advertising campaign that emphasizes “framing” over content is going to have much of an impact. Particularly if the content is understood to be misleading, and the taxpayer funded ad is possibly illegal. But then, if you can’t trust the Sheriff of Mayberry – who can you trust?

x-posted from “Divided We Stand United We Fall”


This entry was posted on Tuesday, August 10th, 2010 and is filed under Health Care, health care reform, Missouri. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

8 Responses to “Congressional Research Service: “The precise number of new entities that will ultimately be created pursuant to PPACA is currently unknowable””

  1. Tweets that mention Donklephant » Blog Archive » Congressional Research Service: “The precise number of new entities that will ultimately be created pursuant to PPACA is currently unknowable” -- Topsy.com Says:

    [...] This post was mentioned on Twitter by Justin Gardner, Donklephant. Donklephant said: DONKLEPHANT: Congressional Research Service: “The precise number of new entities that will ultimately be created pur… http://ow.ly/18vrvb [...]

  2. Chris Says:

    So what’s the concern here? Larger government?

  3. mw Says:

    I think the problem is self evident.

  4. kranky kritter Says:

    The precise number of new entities that will ultimately be created pursuant to PPACA is currently unknowable

    Folks, before we panic, let’s all notice that this sentence doesn’t mean the same thing as “the number is unbounded.”

    There are lots of quantities we all experience in our short term futures whose precise quantity is “unknowable.” Like the number of runs the Red Sox will score Wednesday, or the amount of money we’ll spend at the grocery store on our next trip, or the final tally on our next electric bill.

    But no one panics because they worry that the unknowable amount for our next electric bill might be $1500 instead of in the usual range.

    So if this post is in any sense an invitation to panic and/or presume the worst, I for one am declining that invitation.

  5. mw Says:

    Krankly,
    It’s more like an invitation to read the report, scrutinize the dozens and dozens of identified new agencies, programs, and advisory bodies listed in the appendix, ponder the hundreds of “various demonstration projects, grants, trust funds, programs, systems, formulas, guidelines, risk pools, websites, ratings areas, model agreements, or protocols” that are outside the scope of the report, presume that there is no basis for making any assumptions that anything this massive, convoluted, poorly “designed”, scoped, or even understood can be implemented with predictable results or costs – then panic.

    But it’s your call.

    And while the sentence used in the title does not mean the number is unbounded, the report shows that the scope of the bureaucracy spawned to support PPACA is unbounded by the legislation itself. It is of course ultimately bounded by the percentage of the GDP it can suck up before we go bankrupt.

  6. kranky kritter Says:

    It is of course ultimately bounded by the percentage of the GDP it can suck up before we go bankrupt.

    Well, I wholeheartedly agree with you that we should be worried by the ever-growing share of our resources that is being consumed by healthcare costs. As I have repeatedly stated, healthcare costs continue to grow in the 7 to 10% range annually. Sooner or later, that’s a problem.

    I’m happy to judge the performance of our post-HCR system against its prior performance.

    What I’m not willing to do is presume that the creation of new agencies and so on to adminster HCR will necessarily do more harm than good. You may well be right to imply that the primary “achievement” of HCR is going to be to create more bureaucracy, meaning inefficiency and waste.

    I’m willing to take a wait and see attitude instead of presume that the raw numbers and descriptions you cite are reason for panic. Please notice that I’ve cheerfully acknowledged above that you might be right.Might.

    It might also turn out to be the case that these new agencies etc represent different ways of doing things. Maybe these new approaches are going to replace other ineffective ways of administering healthcare via a series of private but equally inefficient bureaucracies. I’m far too old and experienced to presume that only government can create slow crappy and unresponsive red tape.

    Since this bill has passed via the machinations of a substantial majority of our elected representatives, I am at this point willing to wait and see how it pans out, instead of strangling the wart-scarred baby in its cradle.

    That doesn’t mean that I don’t respect the concerns of folks who are concerned that it will be a disaster. I do respect them. I’m just not much of a panicker, and nothing I’ve read about HCR makes me concerned that HCR will be a disaster. I continue to believe that HCR will improve access but not curb costs, I support he former for moral reasons and worry deeply about the latter for mathematical reasons.

    I am still waiting for folks to coalesce around support for realistic cost control measures. IMO HCR appeal advocates lack any detailed positive insight about where we can quickly and usefully head AFTER we go back to the drawing board, as they advocate. So right now, I am opposed to going back to the drawing board. We spent over a year of contentiousness at the drawing board, and we got what we got.

    I’m for trying what we got. At the very least, we’ll get to see what happens, and go from there. A strong argument can be made for seeing what happens, instead of chickening out and losing another couple years while things continue to deteriorate on issues of BOTH access and cost. That’s where I am.

  7. Chris Says:

    More and larger agencies in itself isn’t horrible, it’s how well they perform and if they do a better job than what was being done previously.

  8. Donklephant » Blog Archive » Fickle Independents and Liberal Postmortems Says:

    […] examples of mind-numbingly bad and jaw-droppingly expensive legislation – ARRA (Stimulus) and PPACA (Obamacare) – that were both made possible and steamrolled by One Party Democratic […]

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