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.

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