Takeaway: DeSantis's star begins its ascent while Neera Tanden's takes dive and dogeared health policy persists

Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans on 2/28/21. CLICK HERE to get COVID-19 analysis and alerts from our research team and access our related webcasts.

A Reversal of Fortune | Pandemic Politics' Narrative, Nominations & ACA  - 01.27.2020 coronavirus cartoon  7


Pandemic politics’ narrative has taken a beating this week. Governor Andrew Cuomo, whose tough guy persona during COVID-19 was held up as a model, is taking heat from left and right over nursing home deaths. Governor Gavin Newsom, whose early action on shutdown orders received a lot of praise is the subject of a fast-moving recall effort.

The “never Trump” Lincoln Project, populated with at least nominally Republicans that ran scorched-earth ads criticizing the White House’s pandemic response, turns out to be a very dark get-rich scheme.

Meanwhile, Governor Ron DeSantis, an outspoken opponent of shutdown orders and other nonmedical pandemic interventions, received 64% in a three-way Republican Party poll against Senators Marco Rubio and Rick Scott, up from 53% last year. His approval rating, which dipped below 50% during the height of Florida’s pandemic, now stands at 54% according to a recent Florida Chamber of Commerce poll. His presidential ambitions are starting to look viable.

As anyone that takes the time to read the CDCs reports on COVID-19 infections, hospitalization and deaths, the rate of change seems frustratingly unaffected by all the things Governor DeSantis resisted.

At the same time, basic economic metrics like unemployment are not. At the start of the crisis, about 100 bp separated the unemployment rates in New York and Florida. In December it was 210.

For the sake of avoiding partisanship, it is important to note that Governors from both parties adopted variations on Florida’s response. None, however, were vilified quite like DeSantis or have demonstrated an interest in the White House. Colorado Governor Jared Polis is just one example.

For those states that adopted draconian measures like New York and California, DeSantis’ arrival on the national stage provides a unique opportunity to offer as a contrast, the pandemic experience of Florida. The comparisons will not be flattering; school closures translate into significant learning delays among younger children; delayed medical care will continue to stress the health delivery system; and economic damage among small businesses will persist.

As the costs of pandemic accrue, a political reckoning seems inevitable and it might just begin in Florida.

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If there was any doubt, Xavier Becerra, President Biden’s nominee for HHS Secretary, made clear at his confirmation hearings that he intends to return to the ACA battlefield. Aside from COVID, preserving and extending the law is the policy priority. The silence from Republicans was deafening.

While the ACA has become an article of faith, a totem for the party faithful, most of the rest of the country has moved on. The great promise of the law sank under the weight of provisions, like a minimum MLR that drove up premiums and health care costs and threaten to make the standard health insurance model irrelevant.

The absence of original policy priorities leaves Republicans, who made careers out of trying to repeal the ACA, perfectly content to let the Biden administration obsess over metal levels, “silver loading,” CSR and other obscurities of the massive law that are only of interest to the denizens of Washington’s think tanks.

Meanwhile the thinking goes, many of the free market policies of the Trump administration will work their way through the health care system, accelerated by COVID’s realities. Employers once thought to be exiting the insurance business are now getting more involved.

It is still early but in the near term, it seems that for the first time in decades, what Washington does with health care won’t matter much


If the righteous indignation of Clinton-world took human form it would look a lot like Neera Tanden. Holed up in think tanks and lobbying firms around Washington, aspiring appointees and nominees nursed their bitter disappointment at Clinton’s defeat, awaiting the inevitable moment when they would return victorious and take their rightful places in and near the White House.

Tanden, from her perch at the Center for American Progress, wielded, not ironically, Donald Trump’s political weapon of choice with skill to express displeasure of everyone from Bernie Sanders to Ted Cruz and a lot of Senators in between. Unfortunately for Tanden, ill-considered tweets now offer Senators charged with confirming her as Director of the Office of Management and Budget a handy excuse to vote “no.”

And an excuse is what it is.

What became very clear in the wake of 911, intensified during the Obama-years and reached terminal velocity under Trump, is that Congress is being shuffled off to irrelevance by Washington’s regulatory apparatus with helpful support from the courts.

There is no one better suited to pulling the enormous levers of that power than Tanden. She was a key architect of the Affordable Care Act while working as a senior adviser to HHS Secretary Kathleen Sebelius. The ACA, which has given rise to so many disputes is, itself, a repudiation of Congress’ and especially the Senate’s deliberative processes. Its poor drafting lent itself to aggressive rulemaking that made the regulatory process unpredictable.

The court have declined to rein some of the more egregious practice of the last two decades. During the Trump administration, the courts even expanded regulatory power by saying, in the context of some site neutral reimbursement policies that if the law doesn’t prohibit it, then the White House can regulate ii.

That leaves Congress with little to do and it prefers a less formidable OMB director.

Tanden will no doubt find another role in the Biden administration as her nomination is likely to be withdrawn in the coming days. Whoever takes the lead at OMB is likely to purse previous administrations’ regulatory ambitions but with a policy priority focused on the ACA, the implications are generally predictable.