Why Delaying Obamacare Could Ultimately Do As Much Damage as Defunding

The GOP-backed one-year delay sounds benign but it would create the kind of chaos that could permanently harm the health insurance program.

Maygan Rollins, 22, a field organizer with Enroll America, holds a clipboard with pamplets while canvassing at a bus stop, Wednesday, Sept. 25, 2013, in Miami. Enroll America is a private, non-profit organization running a grassroots campaign to encourage people to sign up for health care offered by the Affordable Care Act. In less than a week Florida residents can start enrolling for health coverage under the Affordable Care Act. 
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Jill Lawrence
Sept. 27, 2013, 5:07 a.m.

The Re­pub­lic­an plan to delay core as­pects of the Af­ford­able Care Act doesn’t sound as dra­mat­ic as tak­ing away its fund­ing, but it could ul­ti­mately do just as much to crush the con­tro­ver­sial law.

The latest wrinkle in the GOP’s stop-Obama­care strategy is a one-year “delay of everything,” says Brendan Buck, spokes­man for House Speak­er John Boehner. And that does mean everything ““ the new in­sur­ance mar­ket­places, the sub­sidies, the taxes, and in­di­vidu­al man­date that re­quires people to have in­sur­ance or pay a fine.

It would be hard to over­state the im­port­ance of the year ahead for both sides in the health ar­gu­ment. Re­pub­lic­ans are seek­ing an­oth­er year to stoke doubts about the health law, which is already un­pop­u­lar, and to take their re­peal plat­form in­to the 2014 midterms. If they win con­trol of the Sen­ate, they could claim a man­date to kill it.

Pres­id­ent Obama and Demo­crats, by con­trast, have been wait­ing im­pa­tiently for the open­ing of the ex­changes that are go­ing on­line Oct. 1 and are the first chance many con­sumers will have to ex­per­i­ence the law. Obama is count­ing on that firsthand con­tact to change views. As he put it Thursday, after de­scrib­ing the new sys­tem, people don’t have to take his word for it: “Go on the web­site. See for your­self what the prices are. See for your­self what the choices are. Then make up your own mind. That’s all I’m ask­ing.”

Demo­crats like to com­pare Obama­care to the Medi­care pre­scrip­tion drug pro­gram and its tra­ject­ory from res­ist­ance to ac­cept­ance. A month after it took ef­fect in Janu­ary 2006, only 23 per­cent of seni­ors in a Kais­er Fam­ily Found­a­tion poll had a fa­vor­able im­pres­sion while 45 per­cent viewed it un­fa­vor­ably. By Novem­ber 2006, that had moved to 42 per­cent fa­vor­able, 34 per­cent un­fa­vor­able. By the end of 2012, 32 mil­lion people ““ 63 per­cent of those eli­gible ““ were en­rolled in the drug plan.

There is rampant am­bi­val­ence in today’s polls. More than half the coun­try op­poses the law, while few­er than four in 10 fa­vor it. But 56 per­cent in a New York Times/CBS News poll say Con­gress should up­hold the ACA and make it work as well as pos­sible. And a new United Tech­no­lo­gies/Na­tion­al Journ­al Con­gres­sion­al Con­nec­tion poll finds a near-even split: 49 per­cent say Con­gress should keep the pro­gram, 44 per­cent say re­peal.

If the ex­changes did open but the in­di­vidu­al man­date was post­poned, ex­perts say those likely to skip buy­ing in­sur­ance are the young and the healthy ““ just the people most needed to broaden the risk pool and keep in­sur­ance rates low. Sur­ging rates would ant­ag­on­ize the pub­lic. So would the ab­sence of in­come-based sub­sidies. And if the ex­changes did not open at all, after lay­ing ground­work for big changes for the last three years, in­surers and con­sumers would be left scram­bling.

“You could think about an or­derly trans­ition back, but just stop­ping it would be chaot­ic,” says Gary Clax­ton, dir­ect­or of the Health Care Mar­ket­place Pro­ject at the Kais­er Fam­ily Found­a­tion. Among his ques­tions: Would the com­pan­ies have to re­sume un­der­writ­ing, charge high­er rates to sick people, and deny cov­er­age to some? And with many high-risk pools gone in pre­par­a­tion for the big shift, where would those people get in­sur­ance? He also notes that if in­surers lost money as a res­ult of the sud­den full stop, the fed­er­al gov­ern­ment would be on the hook to make up much of the loss, as it was the case with the Medi­care drug pro­gram.

From a polit­ic­al se­mantics stand­point, says Robert Blendon, a health policy ex­pert at Har­vard, “de­fund­ing sounds aw­ful. It sounds like you’re tak­ing money away from sick people.” A one-year delay seems more be­nign, he says, but “could have a very neg­at­ive long-term ef­fect on the vi­ab­il­ity of the law.” That makes de­fund and delay a win-win for Re­pub­lic­ans, and a test of back­bone for Demo­crats.

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