The numbers are still coming in on the Affordable Care Act, and that will continue for years.
There will never be one number that tells the full story of the law’s impact on health care costs, the underlying economic health of the law, its effect on the federal deficit or job creation. Obamacare will be a statistical kaleidoscope for its entire legal life—even after this Congress or another changes it under political duress.
Even so, 7.1 million enrollees is a milestone. It doesn’t guarantee the law will work, and it doesn’t ensure premiums won’t rise or doctors and nurses will be available to provide the care promised by the insurance acquired. But it does represent a watershed moment in the White House effort to preserve what it so conspicuously and comically jeopardized.
Press secretary Jay Carney cannot stop invoking the word “remarkable” to describe Obamacare’s comeback saga. What is so remarkable about an administration, with three years to plan, attaining the agreed-upon goal of enrolling 7 million Americans? That was a number that Health and Human Services Secretary Kathleen Sebelius embraced in congressional testimony and health care hands within the White House thought attainable. The remarkable part is not the number of enrollees on March 31, but that it was achieved after an unprecedented two-month act of self-sabotage.
Having survived that, President Obama’s Rose Garden victory lap—witnessed by Sebelius and White House Chief of Staff Denis McDonough sitting together in the front row—ended a telling chapter in Obama’s approach to presidential leadership. During the darkest days of the website meltdown, Obama made it clear to those who asked that it was crucial for him not to fire any high-ranking administration officials. Sebelius and McDonough both reasonably feared they would be shown the door.
Numerous business executives, even those who wish Obama well, criticized Obama publicly and privately for failing to “hold someone accountable” and using the power of a bureaucratic beheading to demonstrate his fury. Whether this is a sign of strength or weakness, it is characteristically Obama.
Holding a maligned, self-doubting team together in moments of peril is too often oversimplified by the phrase “No Drama Obama.” It’s more complex than that. Obama has convinced himself that scaring people with a ceremonial firing deepens fear, turns allies against one another, makes them risk-averse, and saps productivity. At no time was this distillation of presidential power put to more strenuous administration-wide test. Interestingly, it was McDonough, on a walk Monday at dusk on the South Lawn, who gave Obama the news that enrollment figures were sure to top 7 million.
“At times this reform has been contentious and confusing, and obviously it’s had its share of critics,” Obama said in the Rose Garden. “That’s part of what change looks like in a democracy. Change is hard. Fixing what’s broken is hard. Overcoming skepticism and fear of something new is hard. And a lot of times, folks would prefer the devil they know to the devil they don’t. But this law is doing what it’s supposed to do. It’s working.”
In ways they’ve never discussed before, senior administration officials now admit they feared late last fall that the entire law might collapse under the weight of Democratic defections and aggressive Republican calls for repeal. The mathematics of veto-proof majorities always argued against repeal, but the nightmare of HealthCare.gov followed by the “political lie of the year” on individual insurance policies filled senior Obama advisers with Affordable Care Act existential dread.
Looking back on it now, senior officials heap praise on the triage team led by Jeffrey Zients that rebuilt the website. But they also proclaim with jut-jawed arrogance this unassailable and in retrospect vital political fact: Not one Senate Democrat who voted for Obamacare and only two House Democrats (Jim Matheson of Utah and Mike McIntyre of North Carolina) ever backed full repeal. That reality wasn’t always a sure thing. The party discipline on repeal reflects the tenacity of the Democrats who drove it through every legislative obstacle: House Minority Leader Nancy Pelosi and Senate Majority Leader Harry Reid.
Obama made calls and held some hands. But Pelosi and Reid ran roughshod on the unsettled, herded the doubtful, and schooled the unwitting in the gruesome politics of punishing traitors.
Pelosi met with Obama at the White House Tuesday, and I asked her if she ever feared Obamacare would collapse. “Never,” she said. “It never for one instant occurred to me that the Affordable Care Act would collapse. Yes, the website didn’t perform. We were very disappointed. It was an embarrassment. But it was an episode, and it’s over. And you can’t be afraid of one thing or another. I didn’t even know that that was the mood in the White House. That’s news to me. I never shared that.”
It’s easier now, in retrospect, to declare such anxiety unthinkable. But it was real inside the White House and Democratic cloakrooms. For the White House, talk of vulnerable Democrats running away from Obamacare in the midterms sounds almost quaint. They know the real danger of Democrats running away was in November and December. If they didn’t cut and run then, they’re unlikely to do so now. And the politics now are even simpler than then. Does a Democrat believe he or she can run against Obamacare and attract the Obama coalition?
The White House doesn’t. And unlike Republican strategists, it and Pelosi and Reid have stared down potential defectors. During Obamacare’s worst days, Obama kept his team in place, and so did Reid and Pelosi. The law and its numbers, the revisions and delays will continue to unfold month by month and year by year. But the story of holding the Democrats together on Obamacare is as it was from the start: Obama-Pelosi-Reid, a constellation of constancy amid the chaos.
The author is National Journal correspondent-at-large and chief White House correspondent for CBS News. He is also a distinguished fellow at the George Washington University School of Media and Public Affairs.
CORRECTION: An earlier version of this story incorrectly said that no House or Senate Democrat backed repeal of Obamacare. In fact, two House Democrats—Jim Matheson of Utah and Mike McIntyre of North Carolina—did.
Obamacare Number Crunching
This article appears in the April 2, 2014 edition of NJ Daily as Near-Death Experience.