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Grassley Q & A

Q & A: Health Care’s Sprawling Bureaucracy

September 1, 2010
Dysart Reporter





Q. Will the reforms created by the new health care reform law be easy to implement?

A. No. Implementation of the federal programs in health care reform will require the creation of dozens of new entities, according to the nonpartisan Congressional Research Service. Some of these will be new offices created within existing federal departments or agencies. Others will be entirely new federal entities. The responsibilities outlined in health care reform for many of these entities are incredibly vague and, according to the Congressional Research Service, "in many cases it is currently impossible to know how much influence they will ultimately have over the implementation of the legislation."

Q. What does this mean?

A. It means that unelected bureaucrats will have enormous power in carrying out the reforms outlined in health care reform, giving them vast influence over how these changes to the health care system will affect Americans. It should be noted that any one of these entities could sprout more entities. According to the Congressional Research Service, "The precise number of new entities that will ultimately be created pursuant to [the new health care law] is currently unknowable, for the number of entities created by some sections is contingent upon other factors, and some new entities may satisfy more than one requirement in the legislation" resulting in an "indeterminate number of new organizations." Policy experts estimate that implementation of health care reform will create up to 159 new entities.

Q. How will the entities be established and how will their responsibilities be determined?

A. Entities that weren't specifically addressed in the legislation will not function until staff is appointed and funding is allocated. In some cases, the health care reform law gives no specific indication of who has the authority to appoint staff to an entity.

There are also few, if any, consequences listed for failure to meet deadlines. So far, the dates for establishment of two of the new bureaucratic entities came and went without the entities being created. Most of the other entities don't even have set creation deadlines. This uncertainty is yet another example of how health care reform was rushed through Congress without much thought about the potential consequences, such as an unstoppable increase in the size of the federal bureaucracy.



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