The Republican plan to delay core aspects of the Affordable Care Act doesn't sound as dramatic as taking away its funding, but it could ultimately do just as much to crush the controversial law.
The latest wrinkle in the GOP's stop-Obamacare strategy is a one-year "delay of everything," says Brendan Buck, spokesman for House Speaker John Boehner. And that does mean everything – the new insurance marketplaces, the subsidies, the taxes, and individual mandate that requires people to have insurance or pay a fine.
It would be hard to overstate the importance of the year ahead for both sides in the health argument. Republicans are seeking another year to stoke doubts about the health law, which is already unpopular, and to take their repeal platform into the 2014 midterms. If they win control of the Senate, they could claim a mandate to kill it.
President Obama and Democrats, by contrast, have been waiting impatiently for the opening of the exchanges that are going online Oct. 1 and are the first chance many consumers will have to experience the law. Obama is counting on that firsthand contact to change views. As he put it Thursday, after describing the new system, people don't have to take his word for it: "Go on the website. See for yourself what the prices are. See for yourself what the choices are. Then make up your own mind. That's all I'm asking."
Democrats like to compare Obamacare to the Medicare prescription drug program and its trajectory from resistance to acceptance. A month after it took effect in January 2006, only 23 percent of seniors in a Kaiser Family Foundation poll had a favorable impression while 45 percent viewed it unfavorably. By November 2006, that had moved to 42 percent favorable, 34 percent unfavorable. By the end of 2012, 32 million people – 63 percent of those eligible – were enrolled in the drug plan.
There is rampant ambivalence in today's polls. More than half the country opposes the law, while fewer than four in 10 favor it. But 56 percent in a New York Times/CBS News poll say Congress should uphold the ACA and make it work as well as possible. And a new United Technologies/National Journal Congressional Connection poll finds a near-even split: 49 percent say Congress should keep the program, 44 percent say repeal.
If the exchanges did open but the individual mandate was postponed, experts say those likely to skip buying insurance are the young and the healthy – just the people most needed to broaden the risk pool and keep insurance rates low. Surging rates would antagonize the public. So would the absence of income-based subsidies. And if the exchanges did not open at all, after laying groundwork for big changes for the last three years, insurers and consumers would be left scrambling.
"You could think about an orderly transition back, but just stopping it would be chaotic," says Gary Claxton, director of the Health Care Marketplace Project at the Kaiser Family Foundation. Among his questions: Would the companies have to resume underwriting, charge higher rates to sick people, and deny coverage to some? And with many high-risk pools gone in preparation for the big shift, where would those people get insurance? He also notes that if insurers lost money as a result of the sudden full stop, the federal government would be on the hook to make up much of the loss, as it was the case with the Medicare drug program.
From a political semantics standpoint, says Robert Blendon, a health policy expert at Harvard, "defunding sounds awful. It sounds like you're taking money away from sick people." A one-year delay seems more benign, he says, but "could have a very negative long-term effect on the viability of the law." That makes defund and delay a win-win for Republicans, and a test of backbone for Democrats.