Doyle McManus: Is Affordable Care Act now too big to fail?

04/10/2014 12:00 AM

04/09/2014 5:44 PM

When Obamacare’s first open-enrollment period ended last week, the tally was impressive: 7.1 million Americans signed up for insurance on federal and state exchanges by the March 31 deadline, several million more signed up for Medicaid and a whole lot of Americans younger than 26 got covered by their parents’ plans.

Those numbers represent a significant political victory for Democrats, making it highly unlikely that Republicans will be able to deliver on their promise to repeal the law.

“You’re not going to turn away 7 (million) or 10 million people from insurance coverage,” crowed Sen. Dick Durbin, D-Ill.

That doesn’t mean Obamacare is guaranteed to succeed. The program still faces a series of difficult tests – most important, keeping costs under control so insurance premiums don’t soar in coming years.

And the program is certain not to be universally popular with its participants. Just think: Millions of newcomers to health coverage are about to join the rest of us in those frustrating battles with insurers.

But the enrollment numbers do mean that the main argument Republicans hurled against the law – that it was doomed to collapse – is looking weaker than ever.

They also mean that Democrats now have a chance to shift the health care debate from whether the law should be repealed to how to improve it. Recent polls have found that between 53 and 71 percent of respondents (depending on how the question is worded) favor keeping the law and fixing it.

The White House already has tinkered with the law administratively to soften some of its most unpopular provisions – enraging Republicans, who have accused President Obama of unconstitutional actions. For example, the president has twice delayed implementing the requirement that employers with 50 or more employees offer health insurance.

And it’s possible that the law could be modified, with congressional approval, to scrap the mandate on companies with fewer than 100 workers.

But the biggest, most interesting change that some Democrats have proposed is a new, lower tier of health insurance policies for people who think the premiums on the standard Obamacare plans are too high.

Some health advocates have criticized the proposal, arguing that it would seduce thrifty consumers into low-cost policies that don’t deliver much, and could even deter patients from visiting their doctors because of the higher co-payments they would face. But others argue that as long as the trade-offs are clear, consumers who want a catastrophic plan ought to have that option. They point to insurance industry studies that suggest that adding a lower-price plan to the mix could drive down costs overall, by increasing the number of willing consumers and competition.

So what will Republicans do now?

They’re trapped in a corner of their own making. GOP leaders say their position now is to “repeal and replace” the health care law. But more than four years after Obamacare became law, they still don’t have a consensus proposal for what that replacement would look like.

And if 10 million people or more have gained health insurance thanks to Obama’s long-derided law, they’re going to want to see a fully fleshed-out replacement before they jump ship. The Republicans haven’t provided one, and that’s a prescription for irrelevance.

“The debate over repealing this law is over,” Obama said. Maybe. But the debate over fixing it has only begun.

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