Obamacare Survives, Now Can It Be Fixed?

8 questions and 1 suggestion for durable health care reform.

Secretary of Health and Human Services Kathleen Sebelius speaks during an event in the East Room of the White House February 27, 2014 in Washington, DC.
National Journal
Ron Fournier
March 31, 2014, 5:18 a.m.

Pres­id­ent Obama and his team de­serve cred­it for pulling Obama­care from the brink of dis­aster. Wheth­er it lives to die an­oth­er day de­pends on the an­swer to these and oth­er ques­tions.

1. What are the real num­bers? There is no dis­put­ing that Af­ford­able Care Act sign-ups surged in the past few weeks, des­pite a de­plor­able rol­lout in late 2013. But we won’t know for weeks wheth­er the ad­min­is­tra­tion ac­com­plished its goal of adding 7 mil­lion people to the in­sur­ance rolls, in­clud­ing a plur­al­ity of healthy young adults. The num­bers an­nounced Tues­day, while im­press­ive, are in­com­plete and mis­lead­ing.

2. How will Amer­ic­ans re­spond when their monthly in­sur­ance premi­ums in­crease next year for health plans sold through fed­er­al and state mar­ket­places? The Wash­ing­ton Post noted today that many plans “low-balled” the prices for 2014 to at­tract cus­tom­ers. Premi­ums go up every year, but now the rates are linked to the suc­cess or fail­ure of the ACA mar­ket­places. Double-di­git in­creases are pos­sible.

3. Will the Demo­crat­ic Party suf­fer a re­verse halo af­fect? That is, will voters so as­so­ci­ate Obama’s party with health care that any prob­lems with the sys­tem — everything from high premi­ums to smug doc­tors — get placed at Demo­crats’ feet?

4. Who will get more at­ten­tion — the people who had their plans can­celed and pay more for an equi­val­ent policy that doesn’t in­clude their doc­tor? Or people with preex­ist­ing con­di­tions or young-adult chil­dren who be­ne­fit dir­ectly from the ACA?

5. How will Amer­ic­ans re­spond when they start get­ting fined for re­fus­ing to buy in­sur­ance?

6. Will Re­pub­lic­ans pay a price for block­ing Medi­caid ex­pan­sion in states? If not, will these holes in the sys­tem un­der­mine ACA?

7. Will the GOP win the Sen­ate and gain seats in the House by cam­paign­ing against Obama and his sig­na­ture policy? That out­come is a bit more likely than not. If Re­pub­lic­ans romp in Novem­ber and then win the pres­id­ency in 2016, the law could be dis­mantled.

8. Will com­mon sense pre­vail over par­tis­an­ship? As my col­league Sam Baker noted, “Re­pub­lic­ans pre­dicted it would col­lapse on it­self (didn’t hap­pen), while Demo­crats swore the pub­lic would em­brace it as time went on (also didn’t hap­pen).” The par­tis­ans were wrong (again), be­cause the truth lurks in the middle:

  • The na­tion needs a uni­ver­sal health care sys­tem.
  • A flawed ACA is the best ap­proach that a di­vided and dys­func­tion­al Wash­ing­ton could pro­duce at the time.
  • But for Obama­care to be a dur­able re­form, the ACA needs polit­ic­al and policy in­put from Re­pub­lic­ans. Demo­crats need to be will­ing to cede some con­trol, and Re­pub­lic­ans need to re­spons­ibly ac­cept it.

That’s not go­ing to hap­pen any time soon. Not when “fix it” is an empty elec­tion-year slo­gan for the Demo­crat­ic Party, and when gov­ern­ing from Wash­ing­ton is im­possible for the GOP.

{{ BIZOBJ (video: 4850) }}

What We're Following See More »
GOP Budget Chiefs Won’t Invite Administration to Testify
1 days ago

The administration will release its 2017 budget blueprint tomorrow, but the House and Senate budget committees won’t be inviting anyone from the White House to come talk about it. “The chairmen of the House and Senate Budget committees released a joint statement saying it simply wasn’t worth their time” to hear from OMB Director Shaun Donovan. Accusing the members of pulling a “Donald Trump,” White House spokesman Josh Earnest said the move “raises some questions about how confident they are about the kinds of arguments that they could make.”

Snowstorm Could Impact Primary Turnout
1 days ago

A snowstorm is supposed to hit New Hampshire today and “linger into Primary Tuesday.” GOP consultant Ron Kaufman said lower turnout should help candidates who have spent a lot of time in the state tending to retail politicking. Donald Trump “has acknowledged that he needs to step up his ground-game, and a heavy snowfall could depress his figures relative to more organized candidates.”

A Shake-Up in the Offing in the Clinton Camp?
1 days ago

Anticipating a primary loss in New Hampshire on Tuesday, Hillary and Bill Clinton “are considering staffing and strategy changes” to their campaign. Sources tell Politico that the Clintons are likely to layer over top officials with experienced talent, rather than fire their staff en masse.

Trump Is Still Ahead, but Who’s in Second?
20 hours ago

We may not be talking about New Hampshire primary polls for another three-and-a-half years, so here goes:

  • American Research Group’s tracking poll has Donald Trump in the lead with 30% support, followed by Marco Rubio and John Kasich tying for second place at 16%. On the Democratic side, Bernie Sanders leads Hillary Clinton 53%-41%.
  • The 7 News/UMass Lowell tracking poll has Trump way out front with 34%, followed by Rubio and Ted Cruz with 13% apiece. Among the Democrats, Sanders is in front 56%-40%.
  • A Gravis poll puts Trump ahead with 28%, followed by Kasich with 17% and Rubio with 15%.
CNN Calls the Primary for Sanders and Trump
7 hours ago

Well that didn’t take long. CNN has already declared Bernie Sanders and Donald Trump the winners of the New Hampshire primary, leaving the rest of the candidates to fight for the scraps. Five minutes later, the Associated Press echoed CNN’s call.