The Next Phase of the Obamacare Battle Begins

We're beginning a new phase of the battle over Obamacare—and the fact that we can continue to refer to it as a "battle" tells you something—one that in some ways takes on the appearance of an electoral campaign, with television ads, media events, PR stunts, and a universal assumption that the whole thing is zero-sum. If anything related to Obamacare goes well—like, say, people getting health insurance at affordable prices—then that's bad for Republicans and something they'll do what they can to stop.

What we have here is something truly unprecedented: an opposition party not just insisting that a significant government program was a bad idea, not even just hoping that in its implementation it doesn't work, but committing itself to actively working to make sure the program fails and that as much human misery as possible can be created along the way, so that eventual repeal of the program will become possible.

The Obama administration is facing a huge administrative task, laid on top of which is a challenging political problem. Try to imagine a government trying to build a new bridge, while all throughout their political opponents were not only telling people they'd die if they drove across it, but going out to throw rocks at the construction workers.

Nevertheless, the Obama administration seems to be cautiously optimistic about its ability to overcome the obstacles. They're probably looking at this as a competition between an administration using whatever resources of money, time, and personnel it can muster to systematically work to make implementation a success; and another side that's going about undermining the law through a somewhat haphazard combination of PR efforts aimed more at opinion leaders than at the people who will actually stand to benefit from the law, obstruction on the state level (mostly in the form of refusing to let poor people get Medicaid, a decision so morally despicable it can only be described as evil), and general passive-aggressiveness. On the latter, here's a charming tidbit from Karen Tumulty's piece in today's Post: "Some Republican lawmakers, who routinely help their constituents with concerns about Social Security and Medicare, have even served notices that they do not plan to assist those who come to them for aid in navigating the new health-care system."

Constituents routinely call their member of Congress for help with things like chasing down a lost Social Security check, and the members have staffers assigned to performing that kind of constituent service. It's one of the ways you get re-elected, and I'm pretty sure that them saying they'll refuse to help constituents who call them about Obamacare is just bluffing. But it does show just how deranged many Republicans get when it comes to this issue.

In some ways, the passive-aggressiveness may work to the administration's advantage. For instance, the fact that most Republican states have opted out of running their own insurance exchanges has certainly created more work for the administration, but it also means that if and when they get the exchanges right, they'll be right for most of the country. It isn't that there won't be problems as the exchanges get up and running, because there surely will, but one would hope that once the kinks are worked out, you'll have a system that operates well, run by people within the Department of Health and Human Services who have accumulated the expertise and experience to keep it that way. If I lived in a state run by Republicans who a) never cared much about providing health-care services to their populations in the first place, and b) want nothing more than to sabotage Obamacare, I'd feel much better if my exchange was run by the federal government, rather than by the state government of Alabama or Texas or wherever.

And it is likely that in some ways at least, the opposition will begin to moderate once people begin to actually use and benefit from the law. Already, some states run by Republicans, like Ohio and Michigan, have changed their minds and decided to accept the Medicaid expansion, as the prospect of insuring hundreds of thousands of citizens for almost no money became too good to pass up. And I doubt that a year from now, state Republicans are going to be bad-mouthing their state's insurance exchange when people are going to be more likely to associate it with the state government than the federal government (accurately or not). I don't doubt that the hatred Republicans have for Obamacare is sincerely felt—it may not be rational, but it's sincere. After all, it's got "Obama" right there in the name, so what more do you need to know? But there are going to be diminishing political returns to bashing it.

That said, we won't ever get to the point where we're at with Medicare, where Republicans wish they could destroy it and occasionally propose to do so (e.g. the Ryan budget) but only do so while claiming to love it down to the very depths of their soul. The reason is that even if it's a smashing success, Obamacare will always be somewhat nebulous in the public mind. Yesterday, Ezra Klein noted something I've been saying for years, that the biggest political hurdle to getting Americans to love Obamacare is that Obamacare isn't a program like Medicare, in that people will get its benefits without necessarily being aware of where those benefits are coming from. Most of them will still be getting private insurance, and even if because of Obamacare that insurance is cheaper, more comprehensive, and more secure, they won't necessarily connect those benefits to the law.

So what the administration is hoping for is that we one day get to a point where wonks agree that Obamacare worked, its successes can be touted to those who are politically aware, and Republicans go back to not caring about health care policy and not bothering to attack their opponents about it because they see no particular political benefit therein. That may not sound like a parading-through-the-streets kind of victory, but it would still be worthy of celebration.

Comments

Proving, once again, that any ill-conceived plan, any bad idea, any stack of distortions and lies, can be turned into an attack on Republicans. The goodies-now-reality-later scheme did not build support for the plan. The counted upon healthy-uninsured are not acting as planners expected, the unions are starting to "get it" and we now have imperial delays in the laws timetable. We do not yet know the real costs, or real harm of the ACA, but thanks to author, we do know who to blame. The GOP and everyone who didn't get waivers.

Drivel. I'm still waiting to hear concrete and credible reasons why managed competition, a policy that has worked well in Germany since the 1880s, which has been successfully emulated by Japan, which Republicans ranging from Teddy Roosevelt to Robert Dole to Mitt Romney used to advocate for this country, is destined to be the greatest disaster of all time if implemented in the US (more precisely in 49 states not named Massachusetts)? What exactly is wrong with this country such that what works in Germany and Japan ABSOLUTELY CANNOT WORK HERE? Why would anyone want to stand pat with a system which has consistently delivered a combination of the highest cost and lowest quality healthcare in the developed world for at least four decades running?

Either Waldman is ignorant or deliberately lying. The reason that states have opted out of expanded Medicare is due to the fact that Federal funds to pay for it are time limited. If states agree to expand it now, they're on the hook for it down the road. Given that it is the single fastest growing expense most states have, the smart ones are saying, no thanks. It is NOT because Republicans are evil or don't want people to have health care. They are trying to protect their taxpayers from a future hammering. Democrats believe the magic money tree will provide.

And please explain to me why Republicans should help Democrats implement a stupid, ill conceived law with huge perverse incentives built in when it was passed without a single Republican vote in EITHER house and jammed down the throats of an American public who didn't want it then and STILL don't want it almost 4 years later.

The lies or outright stupidities spewed by Democrats and Obama (if you like your doctor/plan you will be able to keep it; this won't add a single dime to the cost of health care; premiums will go down $2500 per family) have come home to roost. No rational person can support this monstrosity. Republicans are doing this country a tremendous service to continue their opposition. Fortunately there is additional litigation pending that will collapse this law occasioned by Democrats own venality in the drafting.

He could be BOTH ignorant AND deliberately lying. So could you.

Mr. Waldman,
Before the passage of ACA, the eligibility requirement for Medicaid for children was 200 percent of poverty plus family child care expenses. Americans over 65 and those permanently disabled had Medicare. EMTALA required hospitals to treat, regardless of ability to pay. I don't deny that there were problems with our healthcare systems, but they were caused by too much government involvement, not too little.

Why will it fail? Why is it bad policy?

Lack of freedom, for one thing.

I should be able to decide whether and what sort of health insurance I buy. I might prefer to pay for healthcare directly, without involving a third party.

I have purchased an individual policy with an HSA for many years here in Indiana. I don't pay for coverages I don't need: like maternity, chiropractic, etc. And I have insured my family of 4 for about $3800 per year.

Our average actual healthcare expenses are about $1200 per year, which we have paid out of our HSA, and have still built up a tidy savings balance there.

With Obamacare, the price will go over $6500 per year. For which I receive no additional value. In essence, my extra $$$ would subsidize 400 pound diabetic smokers, who will now essentially be in the same risk pool as the health conscious.

AND my taxes have gone up. And no, I won't get a subsidy from my neighbors.

So my best move seems to opt out and self insure. And since there are no pre-existing conditions with Obamacare, in case of catastrophic expense, I'll purchase insurance when the time comes.

And to avoid paying any fine, arrange my affairs such that I never over pay quarterly taxes and thus have no tax refund, the only way the Obamacare fine can be levied.

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