Obamacare’s Problems Could Haunt Democrats for Years

The party’s strategists thought the program would show white voters that government programs can help them. It’s not going so well.

Rocky rollout: HealthCare.gov.
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Ronald Brownstein
Nov. 14, 2013, 11:59 p.m.

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.