Because the Obamacare website is performing better than it did during its admittedly disastrous first weeks, and because congressional Democrats have not defected in the numbers that would have put the law’s near-term survival in question, supporters of the law believe that they have turned a corner. They are convinced that those of us who oppose the law can do no more than temporarily obstruct it, and that the benefits it is starting to bring to the American public will ultimately make it popular and then unchallenged.
In reality, Obamacare remains an unpopular law with deep flaws. It is performing much worse than the advocates predicted as recently as September. At the end of that month Health and Human Services secretary Kathleen Sebelius told NBC Nightly News, “I think success looks like at least 7 million people having signed up by the end of March 2014.” It was last year that the Congressional Budget Office came up with that estimate for the number of people who would enroll in Obamacare’s exchanges. Nobody now expects the target to be hit. The administration is not touting that measure of success any more, and neither are its supporters — even after the supposed triumph of its “tech surge.”
The administration is not providing the information to allow us to evaluate other aspects of its performance. We suspect that in many states, the population in the exchanges is older and sicker, and thus more expensive to cover, than the administration or the insurers had anticipated. We suspect as well that a large percentage of the people whose enrollment the administration is applauding will never pay their premiums, were previously insured but forced off their plans by Obamacare, or both. The truth will, however, eventually out.
And while Obamacare will be able to publicize positive stories — people who finally have help with their medical bills notwithstanding their preexisting conditions, for example — the negative stories will keep accumulating, too. More people will lose their existing coverage, or see their premiums increase, or their choice of doctors restricted. More exemptions will be granted from the law, too. Note that the biggest one so far, the hardship exemption from the individual mandate for people who lost their coverage owing to Obamacare, was announced after the surge. The overall picture does not seem likely to make the law popular.
The premises on which the law was sold also seem to us to be likely to keep unraveling. It is now widely acknowledged that the president spoke falsely when he said his law would let people who liked their insurance keep it; it will soon be clearer that what he said about keeping their doctors was also false. In recent months studies have suggested that merely expanding insurance coverage does not do much to improve health outcomes, or reduce ER visits — which were crucial to the argument of advocates of the law that it would restrain health-care costs.
This is no time, then, for opponents to flag in calling for the repeal and replacement of Obamacare. Republicans should continue to press at the law’s weakest points. They should challenge Democrats to suspend the individual mandate for everyone, legislatively. The exchanges are likely to put serious financial strain on the insurance companies, who will want a bailout; Republicans should seek to repeal the claim on federal money that the law creates for them. And they should explain that conservative reforms can provide care for the sick, and peace of mind for the healthy, without the many costs of Obamacare.
Republicans will then be advocating a better deal for Americans while Democrats are trying to lower the bar for the law’s success — lower it so far that its mere survival qualifies. We trust voters to draw the right conclusions.