Yesterday I wrote about how Obamacare’s Mission Accomplished moment ignores how far the law is from achieving anything close to the actual mission. But this view of the possibilities of repeal is not without its detractors, and others on the right are less optimistic. Ramesh Ponnuru’s piece was getting the most attention yesterday, as providing some #realtalk for the conservative base:
But it’s clear now that one scenario with a lot of purchase among conservative opponents of Obamacare – that the law would “implode,” “collapse” or “unravel” – is highly unlikely. A quick death spiral was always a remote possibility, even if the early troubles of the exchange websites made it look a little less remote. Many congressional Republicans wanted to believe the idea, though, especially because they viewed it as one more reason they could avoid coming up with their own health-care agenda. (This was illogical – if the program was going to self-destruct in months, wouldn’t the country need a replacement ready? – but the psychological impulse was to avoid grappling with health-care issues.)
Supporters of Obamacare see the enrollment numbers as more evidence that the law is here to stay. Of course, those numbers don’t give us any reason to think that the law will do a lot of good at a reasonable price, or that its basic structure can be modified to pass that test. But the supporters are right that meeting the target of 7 million enrollments will make repealing and replacing the law harder. The likelihood of replacement would be higher if there was an alternative that didn’t take away people’s insurance – one that promised to cover roughly as many people as Obamacare does, or even more. Letting people on Medicaid buy into the market by converting much of the program into tax credits, for example, would be more viable than just kicking its new beneficiaries off the rolls.
More along these lines from AllahPundit at Hot Air. And from Phil Klein. I think this echoes what Avik Roy was writing a month ago. And actually, I don’t think there’s any significant amount of space between what I’ve put forward and what Ponnuru, Klein, and Roy are saying.
Broadly speaking, they maintain there will be no quick death spiral which makes the law collapse on itself. I don’t disagree! Obamacare will collapse because of the political ramifications of its policy failure: because it has failed to achieve its promised aims, because it drives up prices for the middle class, because its mandate and subsidy approach pushes people into plans they don’t want for prices they don’t want to pay, and because its base of engaged “winners” is going to be much smaller than what CBO had predicted even in the wake of the Supreme Court ruling.
Now as to the politics of replacing Obamacare, I am more optimistic than the rest because I view the coverage issue as less of a politically difficult problem, especially when the vast majority of people care more about cost than coverage. On this score, the news from the insurers is not good. Reuters reports:
The Obama administration declared victory on Tuesday over signing up more than 7 million people for this year, overcoming technology failures that stymied enrollment in the program’s early weeks and Republican efforts to discredit it in the eyes of consumers. But insurers have already said that the first group of new enrollees under Obamacare, as the law is widely known, represent a higher rate of older and costlier members than hoped. To keep their health plans from losing money in the coming years, many expect monthly premium rates to rise by double-digit percentages in some parts of the country. That could set the stage for a public outcry ahead of congressional elections this year, giving ammunition to Republicans and creating new friction with the White House that could endure into the 2016 presidential election.
This is why the 7 million figure is such a Pyrrhic victory for the left. The pressure for further health care reform to “fix” Obamacare’s mess is already rising, and that political pressure will actually increase given the number of people enrolled in either plans they view as too expensive or in Medicaid programs which strain state budgets and fail to deliver access to care. The more those costs burden states and working families with higher costs, worse coverage, and restricted access, the louder the clamor to pass further reforms. Every candidate in 2016 is going to have a health care plan, and the people will decide which direction they want to go.
Why on earth do some on the left think Obamacare ended the health care reform process? There is no end zone in which to spike this football. And when the 2014 election is through, we can really start talking about what big health care reform is going to come next.
