A Better Obamacare Won’t Save Obama

The website can be fixed, and the Affordable Care Act can start working as intended, but the damage is done — and the president might be, too.

President Obama speaks at a Democratic Party fundraising event in San Francisco, California, on November 25, 2013. 
National Journal
James Oliphant
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James Oliphant
Nov. 26, 2013, midnight

A new CNN poll con­firms what Amer­ica’s col­lect­ive gut has been say­ing for weeks: Obama­care is sink­ing its name­sake.

The num­bers are ugly: Just one in four re­spond­ents say Pres­id­ent Obama is a com­pet­ent man­ager of the fed­er­al gov­ern­ment. For all the hand-wringing about com­par­ing the Health­Care.gov site rol­lout to Hur­ricane Kat­rina, the bot­tom line is that this pres­id­ent, like his pre­de­cessor, has now suffered a sig­na­ture event that has con­vinced a ma­jor­ity of Amer­ic­ans that he is un­fit for the job.

Pil­ing on, the pres­id­ent also scored his low­est marks on hon­esty and trust­wor­thi­ness, with 53 per­cent of those sur­veyed re­spond­ing that they don’t feel Obama is be­ing straight with them. To put it in some con­text, Bill Clin­ton was widely viewed as shifty but com­pet­ent, and Jimmy Carter as hon­est but hap­less. Obama at the mo­ment seems to have com­bined the worst of both worlds.

The CNN res­ults amp­li­fy Obama’s polit­ic­al prob­lem: The Af­ford­able Care Act im­broglio is hav­ing an out­sized ef­fect on his en­tire pres­id­ency, with voters re­as­sess­ing his ba­sic qual­i­fic­a­tions. “This is ser­i­ous,” says Chris Kofinis, a Demo­crat­ic strategist and former chief of staff to Sen. Joe Manchin of West Vir­gin­ia. “This is much more ser­i­ous than I hear some Demo­crats say­ing pub­licly. This is not a tem­por­ary drop.”

Adds John Geer, an ex­pert on pub­lic opin­ion at Vander­bilt Uni­versity, “In a sense, the pub­lic was col­lect­ively will­ing to be pa­tient. That reser­voir of sup­port among in­de­pend­ents and mod­er­ates has evap­or­ated.”

For weeks, Demo­crats have hewn to the party line, ar­guing that once the web­site woes are re­paired and people can en­roll eas­ily, the polit­ic­al cli­mate will im­prove. And Kofinis is in that lot: “Fix­ing it will help turn it around. But not overnight. It’s a lot easi­er to fall — a lot harder to come back.”

But there are also plenty of reas­ons to be­lieve that Obama won’t re­cov­er to any great de­gree — reas­ons bey­ond his­tory, which has shown that once pres­id­ents tumble to this level, they rarely, if ever, re­turn to their pre­vi­ous heights.

One is the fickle nature of news cov­er­age and the pref­er­ence for an­ec­dote over pat­tern. So if this week’s dead­line comes along and the fed­er­al health care ex­change works smoothly, it’s a one or two-day story, maybe a week. It’s not a sev­en-week story, as the Key­stone Kops-style im­ple­ment­a­tion has been. And if the Nov. 30 dead­line ar­rives and in­dus­tri­ous re­port­ers can doc­u­ment con­sumers still hav­ing troubles with the site, then all the ad­min­is­tra­tion’s talk­ing points about im­prove­ment will be rendered ef­fect­ively in­ert.

But there is a more fun­da­ment­al reas­on why the pres­id­ent is go­ing to have a tough time boun­cing back from this: To most Amer­ic­ans, Obama­care re­mains an ab­strac­tion. The dir­ect be­ne­fits of the law are im­par­ted to a re­l­at­ively tiny part of the pop­u­la­tion. Only 12 mil­lion Amer­ic­ans are ex­pec­ted to use fed­er­al and state in­sur­ance ex­changes to pur­chase cov­er­age — that’s about 4 per­cent of the coun­try. And it’s pos­sible many of them have already re­ceived can­cel­la­tion no­tices along with no­tices of rate hikes, which means their at­ti­tudes to­ward the ACA are, for want of a bet­ter word, com­plex.

At the same time, about 13 mil­lion Amer­ic­ans are ex­pec­ted to be­ne­fit from the ex­pan­sion of the Medi­caid pro­gram. Add those two co­horts to­geth­er and you end up with about 25 mil­lion who re­ceive a dir­ect, sub­stant­ive be­ne­fit from the ACA. That’s less than 10 per­cent of the pop­u­la­tion and com­pared with those who be­ne­fit from Medi­care (49 mil­lion) and So­cial Se­cur­ity (62 mil­lion), or even Medi­care Part D (36 mil­lion), a thin slice of the elect­or­ate. More sig­ni­fic­ant, just about every Amer­ic­an will ul­ti­mately take ad­vant­age of those three en­ti­tle­ments; this is not true for the ACA.

What it all means is that even if the Af­ford­able Care Act works per­fectly from Nov. 30 on(and no one is ser­i­ously ex­pect­ing that), those whose lives are im­proved by the pro­gram rep­res­ent just a re­l­at­ive hand­ful of people, many of whom sit at the lower end of the eco­nom­ic spec­trum and en­gage little with the polit­ic­al pro­cess. As Geer says, “They tend not to vote.”

And that’s what’s go­ing to make any sort of re­newed na­tion­al sales pitch by Obama so dif­fi­cult. Among the polit­ic­ally act­ive, the dam­age is done, and no amount of rebrand­ing or re­selling is go­ing to change their per­cep­tion of the product — nor likely, the pres­id­ent.

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