It would be easy to dismiss the Louisiana Lagniappe as a trivial issue: after all, $4.3 billion in a trillion-dollar health-care law is a rounding error. But the haste and carelessness with which Sen. Landrieu's provision was drafted is endemic of the legislation, more broadly.
Allow me to pick a few examples out of a hat. The CLASS Act, a new entitlement for long-term care, was suspended by Health and Human Secretary Kathleen Sebelius, because she couldn't come up with a way to ensure its long-term solvency. The law's high-risk pools, designed to cover people with pre-existing conditions, are spending twice as much per beneficiary as originally projected. And the White House has quietly increased its budget for the law's insurance subsidies by $111 billion from 2014 to 2021.
I could go on, but you get the point. The Affordable Care Act's supporters believe the law to be a thoughtfully conceived, fiscally responsible program that will cover more people while reducing the deficit. There are a lot of reasons to doubt their optimism.