The drama surrounding the government shutdown and potential debt default almost obscured the rollout of President Obama’s Affordable Care Act. Both champions and critics of the measure should be grateful.
More than 8 million Americans tried to log on to federal or state exchanges, despite concerted efforts by conservatives to dissuade them. Software glitches foiled many of these inquiries and undermined supporters’ claims that the program is ready for prime time.
The confusion also underscored again that this measure is the focus of greater partisan rancor than any major U.S. legislation in recent memory. High emotion often distorts reality. The Oct. 1 rollout was interesting, instructive and not all that important. Over the next year or so, there are at least four crucial benchmarks.
• Dec. 15: That’s when we will know if the computer glitches have been fixed and whether the administration has adequately promoted the law in preparation for Jan. 1, when coverage of the uninsured begins.
Interested customers will come back often. The Massachusetts plan – a model for Obamacare – registered an average of 18 inquiries before someone signed up. Young people are patient when awaiting the next iPhone or “Hunger Games” movie, but if the exchanges don’t eliminate the glitches, some prospective sign-ups will be turned off.
The administration doesn’t have its act together. It has enlisted Chris Jennings, a respected expert, as point policy person. There’s a distance, however, between the White House and the Department of Health and Human Services, and the marketing efforts have been much weaker than some proponents advocated.
Celebrities such as Kerry Washington, John Legend, Katy Perry and the Pittsburgh Steelers have promoted the law. But some of the measure’s backers are calling for a far more elaborate effort involving rock stars, athletes and lots of white-coated doctors and nurses.
• April 1: The Congressional Budget Office estimates that 7 million Americans will sign up in the first three months.
Achieving that goal, both sides agree, would be a good marker of early success. Failure would signal major problems. Supporters say more than one-third of the enrollees should be younger people.
• A year from now: One bit of very good news is that health care costs have moderated. If that trend holds over the next year, insurance rates, which factor in risks and likely costs, would probably come down.
• January 2015: More than half the states aren’t participating in a federally funded expansion of Medicaid for poorer citizens; many of these states aren’t participating in the exchanges, either. For the most part, these are heavily Republican areas, where anything associated with Obama is politically lethal.
Zeke Emanuel, a former top Obama adviser on health care who now is a vice provost at the University of Pennsylvania, said the partisan pressure may subside after the 2014 election. Some of the recalcitrant governors, and some newly elected ones, could change course.
“The money is just too good, and they’re going to look at places like California and Oregon and Colorado and see the results are so much better than in their states,” Emanuel said.
He acknowledges that his brother, Chicago Mayor Rahm Emanuel, a former White House chief of staff, fears that this prediction is wrong and that ideology will continue to trump practicality.
The Republican critics are on stronger ground when they reject White House complaints that the Affordable Care Act is a settled issue. No piece of legislation is settled and safe from review, modification or elimination. President Reagan’s tax cuts and President Clinton’s welfare overhaul were reshaped multiple times.
Still, it was a politically frivolous and base-pandering act for House Republicans, who have a less than vigorous schedule anyway, to vote 42 times to repeal the health care law, knowing that would be unacceptable to the Senate or the president.
The Republicans offer few serious alternatives, unless they are responding to political pressures. Consider the politically potent makers of medical devices who have used a plethora of flawed contentions to persuade almost all Republicans (and quite a few Democrats) to try to repeal a small tax levied on their products.
At the same time, Republicans haven’t permitted corrections to some obvious flaws in the initial Obamacare legislation. Remedies of this kind were passed after Medicare was enacted in 1965.
“Obama is taking executive actions that may produce a lot of litigation,” said Joe Califano, who was a top adviser to President Johnson when Medicare was passed, “because Republicans won’t allow even simple things to be fixed.”
Some of the claims made by these congressional critics are simply disingenuous, such as the assertion that people with pre-existing conditions are already allowed to keep their coverage so they don’t need Obamacare. That’s true of those who have coverage, but for those with illnesses who aren’t insured, insurance is difficult to get. Even for those who are covered, there’s little to prevent insurance companies from jacking up rates. That will change under Obamacare.
Such benefits, the moderating cost of health care and the surge of interest in the exchanges all augur well for the Affordable Care Act in these early stages. But there’s an ominous offset: The political fiascos with the government shutdown and possible debt default have, as the political right hoped, elevated cynicism about the federal government as a whole. Logic suggests that negative sentiment will also be directed at a huge new federal program such as universal health care.