When politics get in the way of policy

There's policy as envisioned, and there's policy as implemented. The latter can be especially problematic when the administrator of such policies has to support policies that s/he does not agree with. Kaiser Health News reported on how the current White House administration has undermined elements of the Affordable Care Act by, for example, reducing advertising for health insurance options during open enrollment. States like California have tried to blunt such impact by spending their own advertising dollars.

However, the article highlighted what seems like might be purposeful desire of the White House administration to spite the state of California by denying the managed care organization tax, "a surcharge on the managed-care plans that provide coverage to about 10 million enrollees on Medi-Cal, California's public health insurance program for low-income people." California expected their request to be approved -- similar to how Michigan's request was approved -- but California's request was instead denied. At stake appears to be roughly $2 billion in revenue for Medi-Cal. Arguably, California and other states should have found a way to make up for the shortfall before the tax expired, but if so, there is a question of fairness in that it is unclear why Michigan's request was approved. We often think about the government setting neutral policy and sometimes forget that real human beings are involved, who might make decisions that undermine the stated policy.