I want to follow up on what I wrote Friday about those who are deciding that because of a) web site problems and b) the largely manufactured controversy over people who have one private insurance plan but now face the unfathomable horror of moving to a different private insurance plan, the Affordable Care Act is an unrecoverable disaster that has destroyed Barack Obama's second term. I'm sensing that this is about to move into a new phase of inane speculation that we should think about before it starts.
I'll just use one article as an example. This morning, under the headline "Why Obamacare Is On Life Support," Josh Kraushaar of the National Journal all but declares that the law is about to be repealed. "Unless the HealthCare.gov website miraculously gets fixed by next month," he writes, "there's a growing likelihood that over time, enough Democrats may join Republicans to decide to start over and scrap the whole complex health care enterprise." That's so blindingly stupid I'm almost not sure where to start, but let's give it is a shot. First, would it really be "miraculous" if Healthcare.gov got fixed by next month? It's a website. Yes, a complicated one, and yes, one that had many problems. But it isn't as though those problems are somehow beyond the ken of human ingenuity to solve, requiring heavenly intervention. The administration isn't trying to achieve faster-than-light transport or make us all immortal. It's a website. It may not be perfect, but it'll work.
Kraushaar then goes through some counting of vulnerable Democratic seats in both houses to argue that it's a real possibility that a repeal of the entire ACA could not only pass, but pass with a wide enough margin to override a veto from the President. His main evidence is the 39 House Democrats who voted last week for a symbolic Republican proposal to undo some of the individual-market reforms; he thinks the the number for full repeal of the ACA will be even greater. But that's completely backwards. It would take some kind of as-yet-unforeseen utter catastrophe to transform even those votes into a vote for full repeal. As Jonathan Bernstein says, "There's an enormous difference between playing along on a symbolic vote and abandoning a policy Democrats are stuck with, like it or not." Not even House Democrats from swing districts are dumb enough to think that voting to repeal the law would serve their political interests, despite Kraushaar's bizarre and demonstrably false assertion that already, "Even [the ACA's] most ardent supporters are running for the hills."
If you're going to start speculating about repeal, you have to confront what's going to happen six weeks from now, on January 1. Let's have a little reminder:
- Millions of people will begin getting coverage through Medicaid. Repeal would mean kicking these people off their insurance.
- Millions of people will begin getting subsidies to pay for private insurance. Repeal would mean taking away their subsidies, making it unaffordable for them to get insurance.
- Denials for pre-existing conditions will be officially over. Repeal would mean that once again, insurers could deny people coverage if they've ever been sick.
- Annual limits on coverage will be outlawed. Repeal would mean that people will once again start being forced to pay huge medical bills, in many cases forcing them into bankruptcy, if they have a serious illness or accident.
And that's not to mention the parts of the bill that have already gone into effect, like "rescission" becoming illegal, children not being allowed to be denied coverage for pre-existing conditions, or young people being allowed to stay on their parents' insurance until they're 26. You think some news stories about people in the individual market having to pay more for a new insurance plan tug at lawmakers' heartstrings? Wait until you see the stories about the 5-year-old girl with leukemia who'll get kicked off her coverage if Republicans in Congress have their way. Right now we're talking about a few people who are supposedly the "losers" in the ACA, but the most they've lost is some money they'll have to pay for a more comprehensive plan. If you repeal the law, the country would be overflowing with people whose losses are genuinely catastrophic.
January 1 is the end of any talk of repeal, and Republicans know it—as many of them have been saying all along, once you start giving people benefits, it's all but impossible to take them away. That doesn't mean there isn't still work to do, and it doesn't mean there aren't things that could go wrong. Nor does it mean there might not be piecemeal fixes to one or another provision debated in the future; there almost certainly will be. But unless you think that in the next six weeks Republicans are going to manage to put together a two-thirds majority in both houses of Congress to repeal the ACA—something you'd have to be nuts to believe—it's never going to happen.
I realize that there's an impulse as a reporter or a pundit to cast everything in the most dramatic terms possible. "Things are neither perfect nor disastrous" is a much less interesting assertion to make than "Everything has changed! Earth-shattering developments are afoot!" But that happens to be the truth.