The embattled HealthCare.gov site features a time line for implementation of the Affordable Care Act. It ends in 2015.
If there was any chance that health care reform would soon feel more like the law of the land and less like a piñata that gets refilled and rehung daily, the White House essentially put that notion to rest this week when it punted the deadline for medium-sized employers to comply with the law yet another year.
Now, businesses with 50 to 100 employees have until 2016 to offer their workers affordable insurance or pay a penalty — just about the time presidential primary season is getting underway and this president is rendered an afterthought.
The policy effect of the delay on the ACA is minimal, most experts say. But in the political battle over Obamacare, now in its fifth smash year, the news was one more indication that the front has moved to the next presidential election and beyond to the incoming administration.
The law "will be on the front burner in Washington and in every Republican campaign through 2016," predicts Patrick Davis, a GOP consultant in Colorado.
That election likely will mark the fourth straight election cycle in which the ACA is a major issue, if not the central issue — an eternity in politics. Call it Obama's Forever War. "It's the gift that just keeps giving," says Douglas Holtz-Eakin, the former chief of the Congressional Budget Office during the Bush administration, who launched a conservative health care think tank last month.
Holtz-Eakin is among many critics who viewed the delay of the employer mandate as a means for the White House to avoid ugly headlines. The requirement at least raises the possibility that, faced with the deadline, businesses will hire fewer full-time workers or, more dramatically, deep-six their health care coverage outright and dump workers into the ACA's insurance exchanges.
Supporters of the law have long insisted that won't happen, but kicking the mandate down the road is one way to help ensure that if that does occur in large degrees, it might be Hillary Clinton's problem, not President Obama's.
In the meantime, the drip-drip-drip of Obamacare's ups and downs remains a preoccupation of both Republican message-makers and the Washington press corps. Along with the mandate delay, the last week has seen a furious battle over a CBO report about the effects of the law on the labor force and more close-quarter combat about the total number of enrollees on the exchanges.
The ACA continues to devour far more political oxygen than it should given the relatively few Americans it currently affects. There was, not that long ago, a thought that the exchange rollout might cement the ACA's place in the firmament. But the HealthCare.gov fiasco scrambled that calculation. Now, says Holtz-Eakin, "there's no end in sight."
Politically, the White House and vulnerable Democrats in Congress have rocking on their heels ever since. Something like the mandate delay emboldens Republicans who believe — whether it's sound strategy or not — that the law is vulnerable to renewed attack.
"Every time the administration gets cute and thinks they can manage Obamacare as a political liability with a delay, they basically ensure that action provides Republicans with yet another opportunity to drive a contrast before voters," says Kevin Madden, a former Mitt Romney adviser who now works as a GOP strategist.
Such delays, frets Democratic Leadership Council founder Al From, reinforce the view that the federal government simply isn't up the task of working out the details of large-scale reform, weakening his party's argument for continued control of the White House. "When people have no faith in government, they vote Republican," he says.
And in another sign that the GOP is thinking about 2016, party leaders have been re-tailoring their political message, using fewer scare quotes to rally the base and framing the argument against the ACA in Reaganesque phrases about entitlement versus work. Witness Rep. Paul Ryan's comments last week about the law being a "poverty trap" that robs people of the "dignity of work."
On a policy level, the shaky start means that it will take even longer for the benefits of the law, including whether the plans available under the exchanges are worth the cost, to reveal themselves to the majority of Americans who remain skeptical.
Two or three years at a minimum, says Drew Altman, president and CEO of the Kaiser Family Foundation. "There will be implementation land mines for a very long time" allowing Republicans to chip away at the law's foundation by what Altman calls "death by anecdote."
The first benchmark will come this spring if the administration fails to meet its own goals for enrollment and for the mix of the young and healthy to the risk pool. While analysts say the make-up of the federal pool is rather insignificant compared with the composition of state pools, GOP critics won't hesitate to pounce on the shortfall.
Another involves the now-delayed employer mandate. Since employers are not yet required to certify that they offer their employees coverage, that means there's no way to verify whether those workers are eligible for subsidies on the exchanges. (It's been called an "honor system.") That will, Holtz-Eakin says, inevitably lead to cases of fraud uncovered by the media.
A third and more potentially troublesome flashpoint will come closer to midterm Election Day, when consumers and small businesses face another round of policy cancellations in advance of 2015. Many businesses locked in their 2014 rates early last year in fear of the ACA — and some could experience steep premium hikes. That could damage Democratic prospects for retaining Senate control at a critical time.
It's a cascade effect. A GOP takeover of the Senate would then ensure Congress would be in full anti-ACA mode through the 2016 campaign, passing legislation that likely would be vetoed by Obama. "It guarantees two more years of this," says Mo Elleithee, spokesman for the Democratic National Committee.
Obamacare will haunt Democrats in other ways by then. When the White House delayed implementation of the so-called "Cadillac" tax on high-dollar health care plans to 2018 because of union objections, it ensured that the next wave of candidates for president will be under heavy pressure to pledge to repeal the tax as a condition for labor support. Doing so would renew cries of favoritism and selective enforcement that are dogging Obama now. The same would happen if the White House decides, as some have speculated, to scrap the employer mandate outright before it does any harm.
And if Clinton runs, she'll have to run as the architect of the individual mandate, the requirement that everyone purchase health insurance. (Obama basically co-opted that aspect of her plan.) Should a challenger "take even one step away from the mandate inside a Democratic primary," Kevin Madden says, "the party would fracture."
None of this means continually hammering away at the ACA for the next three years will secure the White House for the GOP. Elleithee, naturally, sees it as a political loser. And Democratic strategist Steve McMahon contends time is needed for the political narrative to be rewritten. "The boogeyman stories always seem to punch through," he says. The law "will get there eventually."
Remember that ACA timeline? It's growing longer by the minute.