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How This One Magic Number Saved Obamacare

Under Obamacare, we were told we could keep our plans, we could keep our doctors, and our premium costs would go down. None of that has happened.


Have you heard? Obamacare survived! It got to that magic number it was looking for to make everything right!

Or rather, it got to half the number the Congressional Budget Office predicted it would get to after the Supreme Court ruling.

Either way, it’s totally okay now and is absolutely going to survive and be the law of the land forever and ever despite anything those nasty opponents of the law tell you.

This is a perfectly logical position to hold if you believe that the election of Hillary Clinton in 2016 is inevitable. However, if you believe there is a possibility she is not the next president of the United States, you have to evaluate this rather differently.

All the 7 million number the White House will be touting for months to come really achieves is an end to the “website is broken” storyline which began unexpectedly last fall. Opponents of the law, who had expected all the other disruptions that Obamacare spawned (the substance story of people losing their plans, losing access to their doctors, the broad disruption to employers and employees), were given an additional process story in the broken exchange and bungled launch and collapsing state exchanges. That latter storyline overwhelmed people in both parties – it was such a public faceplant that it made things seem even worse. But it was also a story that was destined to end eventually – indeed, it’s surprising it lasted for a full six months! – and it has largely ended due to all the exemptions, waivers, loopholes, and extensions the Obama Administration has slapped all over this launch process, like using bumper stickers to hold a jalopy together.

This is why talk of the 7 million figure as salvation from supporters of the law is completely bonkers: all you did was meet your lowered policy expectations. In 2014, it is clear that Republicans intend to run against Obamacare: it is a hot button issue for their base, it is perfectly designed to turn their voters out in a base election, and they don’t even need to coalesce around a specific legislative alternative in order to get those votes (rather, they can continue to let a dozen different options sprout here and there). If the odds play out as they currently appear, this positioning will allow them to take the U.S. Senate.

Then the 2016 cycle will be upon us, and at that point, Republicans will ultimately choose a nominee (primarily because they have to) – and this nominee will have a replacement plan for Obamacare. That will effectively become the GOP plan, and the party will run on it. This plan may not become law: but it will be the framework for the reform they push in the wake of the 2016 election should they take the presidency.

The reason the number of people signed up for Obamacare – via the exchanges or Medicaid – matters is that it is, unexpectedly, a much smaller number than originally anticipated. This is in part due to the failure of the approach, and in part due to failure of execution.  What is truly surprising is the degree to which the previously uninsured have not signed up for either program. We’re dealing with a far smaller magic number of beneficiaries than CBO expected:


If the trend line continues, the possibility of a Republican nominee confronting a scenario where fewer than ten million previously uninsured view Obamacare as their ticket to insurance is far more politically palatable than one where nearly three times as many previously uninsured people were supposed to be locked firmly into the program by 2017 (Table 3).

The Republican Party is wedded to the repeal of Obamacare for the foreseeable future. There will not be a single viable candidate in 2016 who is not in favor of repeal or avoids the challenge of putting forward a health care policy designed to replace Obamacare should they be elected. The health care law’s stumbles out of the gate were unexpected, and it’s understandable that supporters would look for any silver lining as a sign of hope that this approach would be a success. But it is a mess. It will continue to be a mess. The winners are heavily outnumbered by the losers at the current moment, and there is no sign that a bend in the cost curve or a shift in premiums will change that dynamic. Supporters of the administration will try to find poll numbers that indicate avenues to success or achieve more support for the law. But the negatives of the law have eroded support among the very constituencies who were supposed to love it.

President Obama promised that under his law, we could keep our plans, we could keep our doctors, and our premium costs would go down. None of that has happened. And unfortunately for supporters of the law, that’s what people care about. All Obamacare had to do to be a popular success was to work – was to match up with the expectations President Obama and the Democrats set for it. If it did, they would be running on the issue for a generation – if it didn’t, the issue would be a weapon for the other side.

It hasn’t. They can’t. It is. And if you think I’m wrong, there’s a handy test for that this fall: it’s called the ballot box.

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