President Obama’s health care law is now compounding a political problem it was meant to solve: the generation-long loss of faith in government activism, particularly among the white middle class.
For decades, Democratic strategists have viewed universal health care as their best opportunity to reverse the doubt among many voters, especially whites, that government programs can tangibly benefit their families. Now the catastrophic rollout of the health law threatens instead to reinforce those doubts. That outcome could threaten Democratic priorities for years.
Even before its disastrous launch, the health care law faced anxiety about its goals. On the plan’s best days, polls found Americans split almost evenly on whether reform would benefit the country overall. But even then, nothing approaching a majority ever said the law would help their own families; among whites, fewer than one-third said they expected to personally benefit. Far more whites said the law would help the poor or uninsured. That meant, as the law debuted, most whites viewed health care more like food stamps than Social Security.
With its chaotic launch, the administration has now added derision over the law’s execution to suspicion about its motivation. In fairness, the health care law, which reported modest but not horrific first-month enrollment numbers, is not the first social program to stumble out of the gate. Social Security initially faced what one historian called “grave administrative difficulties.” Although the Children’s Health Insurance Program passed under Bill Clinton is now widely praised, enrollment grew slowly, as the Center on Budget and Policy Priorities noted this week.
Donald Kettl, dean of the University of Maryland’s Public Policy School and an expert in public administration, points to other mitigating factors in the health law’s struggles: the technological complexity of constructing online exchanges assigned so many tasks; the unexpectedly large number of states that refused to establish their own exchanges; and an unprecedented level of political resistance during implementation.
And yet even with those caveats, Kettl says no major federal initiative has failed so thoroughly upon its unveiling since the ballistic-missile program’s first years in the 1950s produced a succession of explosions and failures to launch. “The last time something blew up on the runway like this,” Kettl says, “things were literally blowing up on the runway.”
The aftershocks from this failure are already rattling many windows. The most immediate damage is measured in Obama’s declining ratings for competence, trustworthiness, and overall performance. Although surveys have not yet found any gusting demand for repeal, they continue to record gale-force misgivings about the law’s impact, particularly among whites. In the exit polls taken during Virginia gubernatorial election last week, two-thirds of whites said they opposed the law; incredibly, a 52 percent majority of white voters said they strongly opposed it (three-fourths of minorities, meanwhile, said they backed the law).
This resurgence of resistance has emboldened Republicans and significantly increased the odds that the 2016 GOP presidential nominee will again run on repealing the law, as Mitt Romney did in 2012. It has also unnerved the president’s party. The Democratic confusion was visible in former President Clinton’s suggestion this week that Obama should allow consumers receiving cancellation notices in the existing individual market to keep their current plans.
Because the individual market now largely excludes the sick (through rules such as denying coverage for preexisting conditions), the relatively modest number of Americans who use it tend to be healthy. If they are allowed to remain outside the new system, the more comprehensive policies sold on the exchanges could tilt too heavily toward the old and sick. And that, notes Jonathan Gruber, a Massachusetts Institute of Technology economist, “would generate a huge [premium] rate shock in 2015” that could further discourage the healthy from enrolling and risk a fatal downward spiral.
Even if the former president intended to distance Hillary Rodham Clinton from the backlash with his remarks, his remedy would expose her, and other Democrats, to greater risk that the new system will sink entirely and submerge them all in future elections. Helping those losing policies to afford new coverage makes more sense for Democrats than allowing them to remain outside the system.
As the health law teeters, the stakes are so great because the struggle encapsulates each party’s core argument. It embodies the Democratic belief that society works better when risk is shared—between young and old, healthy and sick—and government intervenes in private markets to try to expand both security and opportunity. The fury of the Republican resistance reflects the party’s insistence that markets work best unfettered, that centralized government programs cannot achieve their goals, and that Democrats are unduly burdening the “makers” to support (and politically mobilize) the “takers.”
If most Americans conclude Republicans are right about the health care law, that judgment would inevitably deepen doubts about other government initiatives. In this world, Democrats could still hold the White House in 2016 around cultural affinity, but they would likely struggle to achieve much if they do. If the president can’t extinguish the flames surrounding Obamacare, this runway explosion could reverberate for years.
Obama's Sincerest Apologies
This article appears in the November 16, 2013 edition of National Journal Magazine as Failure to Launch.