Mandate watch: We seem to live in a magical world!

FRIDAY, FEBRUARY 17, 2012

Who does Obama’s accommodation accommodate: Our public discourse rarely makes sense.

Often, twists and turns in the public discourse seem to happen by magic. For ourselves, we remain confused by the semi-magical solution Obama came up with last week—his “accommodation” on the birth control mandate.

His accommodation did work, as if by magic. The whole tilt of the public debate quickly turned in his direction. On the politics, that's the tilt we prefer. Having said that, we were a bit puzzled by the way the accommodation would work.

Explanations were few, as always.

Yesterday, our puzzlement grew. On the front page of the New York Times’ Business Day section, Katie Thomas wrote this semi-surprising news report. “Self-Insured Complicate Health Deal,” the headline said. Reading Thomas’ gloomy assembly of facts, it was hard to see how Obama’s accommodation was supposed to accommodate a fairly wide range of players:

THOMAS (2/16/12): The Obama administration thought it had found a way to ease mounting objections to a requirement in the new health care act that all employers—including religiously affiliated hospitals and universities—offer coverage for birth control to women free of charge.

It would make the insurers cover the costs, rather than the organizations themselves.

But the administration announced the compromise plan before it had figured out how to address one conspicuous point: Like most large employers, many religiously affiliated organizations choose to insure themselves rather than hire an outside company to assume the risk.

Now, the organizations are trying to determine how to reconcile their objections to offering birth control on religious grounds with their role as insurers—or whether there can be any reconciliation at all. And the administration still cannot put the thorny issue to rest.

We were surprised to learn that “most large employers” self-insure, since the accommodation doesn’t seem to accommodate folk in that situation. And good lord! When Thomas said “most,” she wasn’t kidding:

THOMAS: Nationwide, 60 percent of workers with health insurance were covered by a self-funded plan in 2011, according to the Kaiser Family Foundation’s annual survey of employer health benefits. Among large employers, the number is even higher. Eighty-two percent of covered workers at companies of more than 200 employees had self-funded plans.

Insurance industry experts and Catholic groups said they did not know how many religiously affiliated organizations self-insure, but they said the number was likely to mirror the national trend. Many of the organizations are large employers, including hospital systems and universities.

Say what? As if by magic, the accommodation flipped the public debate. But based on Thomas’ report, it seems the accommodation has a ways to go. Or something.

We simply don’t understand this topic. We will guess the chances are good that you may not understand it either. Last night, we saw Rachel Maddow citing this Los Angeles Times report as she discussed the way those 28 states already have a mandate like the one Obama proposed.

We haven’t had a chance to review that report in detail. But we’ve learned to be very careful about accepting Maddow’s representations in matters like these. Meanwhile, in just a quick skim, we’ll have to admit that we noticed this paragraph:

GEIGER (2/16/12): The original Obama regulation, released in January, went further than any state by requiring that women receive contraceptive benefits without co-pays or deductibles, as required for all preventive care under the healthcare law. But in exempting only some religious organizations, the administration followed what had become the approach used by many states.

Say what? “Went further than any state?”

We don’t understand this topic. We will guess that you may not understand it either; we’ll be reading more about it this weekend. But our discourse often seems to work by a form of magic.

One thing’s for certain—information and clarity are rarely part of the brew.

Lizard brain reaction alert: We’re not discussing what you think should happen in the best of all worlds. We’re discussing the facts and the logic of the public discussion—a discussion we don’t understand.

Maybe you do! Having said that, where can we get down a bet?

We'll be studying that L. A. Times report. In our view, the New York Times has still been very sketchy when it comes to the basic facts of this case.