The ACA's Obamacare Problem

AP Images/Evan Vucci

Obamacare is well on its way to being permanently unpopular. A problem for supporters of health-care reform? Not really—because the Affordable Care Act (ACA) could become just as untouchable as Medicare or Social Security. That’s right—get ready for “keep your Obamacare away from my Affordable Care Act!”

Okay, not literally; they won’t actually know that the ACA exists. But that’s what they’ll be saying, in effect.

From the very beginning, and certainly before Democrats also adopted “Obamacare” as the shorthand name for health-care reform, Republicans have strongly opposed a fantasy version of the landmark legislation. Whether it was “death panels,” or “government takeover,” or any number of wacky claims in chain emails, Republican opposition has rarely been focused on what’s actually in the ACA.

And no matter how successful reform turns out to be, that’s unlikely to change.

See, the funny thing about the Affordable Care Act is that a whole lot of it will either be invisible or, oddly enough, won’t be identifiable as “Obamacare.” The core of the program is the system of health-insurance exchanges and subsidies, but little or none of these operations will have the words “Affordable Care Act,” much less “Obamacare,” attached to them. Nor are the exchanges what people think of going in as Obamacare. The latest Kaiser health reform tracking poll has only 22 percent of respondents saying they’ve heard “a lot” or “some” about the exchanges (and among the unemployed, that number is only 12 percent). So there’s little expectation built up that health reform should be judged by how the exchanges work.

That’s not likely to change. For the minority who will buy insurance on the exchanges right away, it will be obvious that something is new and different, and many of them will associate it with reform. But over time—and, my guess is, rather quickly—the exchanges will just be something that’s always been there. It won’t seem very government-y, after all: It’s just going to look like a web site hosting a bunch of private health-insurance plans. Most consumers will remember the name of their insurance company; far fewer will remember the trying-to-be-catchy name of the web site, and of those, only a small minority will associate it with all that fuss that people in Washington were talking about.

Now, under the hood, there is all sorts of government intervention going on—all sorts of new regulations about what insurance companies can do, how they must spend their money, what products they are allowed to offer through the exchanges. But that’s all going to become invisible to consumers over time.

Even things which, for the first group of exchange users, will seem like a big deal. For those currently without the insurance they want because of a pre-existing condition, becoming newly eligible for coverage will be an obvious effect of Obamacare. But for the next generation (and I mean in as short a time as a year), most people will have no idea that they would previously have been bounced—just as almost no one will realize that they would have once been subjected to yearly and lifetime benefits caps, or would previously have been at risk for a rescission if they ever filed a claim.

And that’s for the most visible part of reform. Medicaid expansion will make a big difference to people, and at first some may realize that’s a feature of Obamacare, but eventually it’s just going to be Medicaid. Cost savings from Medicare, and (if things go right) a spillover effect into private insurance, will be even more difficult for consumers to notice.

As far as the subsidies are concerned, that will mean the cost of insurance really does go down for a lot of people. But I suspect that, too, won’t be perceived as a government program the way that Medicare or Pell Grants are.

People on Medicare are, well, on Medicare. People who receive Pell Grants receive Pell Grants. People who take I-95? They really do know that I-95 exists.

But I can guarantee that three years from now, if the ACA works as its sponsors hope, quite a lot of people—maybe the majority—who get their insurance from the exchanges will tell you that, no, they have private insurance; they aren’t getting anything from Obamacare.

I used to think that would mean that once implemented, Obamacare would become invisible. That’s not quite right, however. If it works, the Affordable Care Act will become invisible. But as long as Rush Limbaugh has a microphone, the odds are that he—and every Republican politician—will be claiming that every single thing that goes wrong with health care, health insurance, and probably the economy and the environment and your favorite football team having a bad season are all Obamacare’s fault.

All of which means that the Republican core who keep the TV tuned to Fox News will be ever-vigilant against the threat constantly posed by Obamacare. Even as many of them will be just as certain as ever that American health care is obviously the best in the world, and far better than what those socialist Europeans have and what the liberals want to ruin with Obamacare. Fortunately, the Limbaugh self-employed listener will think, I don’t have Obamacare; I have the private health insurance I purchased on that StateCare web site. But if the liberals had their way, everyone would be forced to have Obamacare, and—and—America would be ruined.

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