Scandal Sheet

Obamacare future is all about the politics

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The New York Times considers Obamacare’s political ramifications, which is essentially a consideration of the future of the law:

When Franklin D. Roosevelt established Social Security, he created generations of loyal Democrats. When Lyndon B. Johnson signed Medicare into law, he built on that legacy, particularly with older Americans. And when George W. Bush instituted a new prescription drug benefit for Medicare, it helped reclaim elderly voters for Republicans. But President Obama’s Affordable Care Act, the $1.4 trillion effort to extend health insurance to all Americans, is challenging the traditional calculus about government benefits and political impact. Even as Mr. Obama announced that eight million Americans had enrolled in the program and urged Democrats to embrace the law, those in his party are running from it rather than on it, while Republicans are prospering by demanding its repeal. The reasons are complex and layered in the early assessments, but say much about the nation’s political polarization, its shifting fault lines of class and race, and a diminished faith in government.

Democrats could ultimately see some political benefit from the law. But in this midterm election, they are confronting a vexing reality: Many of those helped by the health care law – notably young people and minorities – are the least likely to cast votes that could preserve it, even though millions have gained health insurance and millions more will benefit from some of its popular provisions. “The angry opponents are more mobilized than the beneficiaries,” said David Axelrod, the longtime adviser to Mr. Obama.

Ross Douthat has more on the moveable goal posts and unclear politics of the law:

Before we entered into the agony of the botched roll-out, the law’s supporters were eagerly citing the persistently low rate of health care inflation as a sign that Obamacare was already working as designed, already having a beneficial effect. But as Vox’s Sarah Kliff reported yesterday, the latest inflation numbers cast some doubt on that hopeful hypothesis, with federal data indicating “that health care spending is now growing just as quickly as it was prior to the recession.”

Now this may be temporary: Some kind of cost inflation was always likely to be associated with this year’s roll-out of subsidies and Medicaid spending, and the law’s supporters can reasonably argue that we should wait a few years, until the coverage expansion (however large) has become a normal feature of the system, to judge Obamacare’s impact on inflation overall.

But at a certain point that judgment will need to be made. So, again, what should be the standard? What should be the baseline? Does Obamacare need to hold inflation to the low 2011–2012 pace (a pace, again, that many liberals wanted to credit to its early impact) in order to be counted as a cost-containing success? Does it just need to hold inflation below, say, a 10 or 20-year average? (Note that both on its own terms and relative to overall inflation, health cost inflation had been declining for seven years before Obamacare was passed – so just holding either rate below the average of 2000–2010 would not actually be that impressive.) In other words – what does the Affordable Care Act have to achieve in order to live up to its name?

This brings me back to the two-edged sword of the reality that Ezra Klein talked about here. Klein’s point was that Obamacare is working, albeit unevenly, because it’s more state-based than people in Washington would like to admit, and because the Medicaid SCOTUS decision made the implementation even more uneven than expected. As a general matter, he’s right: The experience with Obamacare will be very different depending on the state you’re in (as many folks have noted in the past, in a heavily regulated state like New York or Massachusetts, the law can make for positive experiences in a host of ways). But this cuts both ways, politically. The fact that outside of DC, Obamacare doesn’t exist means that the positive experiences from “beneficiaries” aren’t viewed as the result of Obama’s policies, which are for the layperson tied up in the debacle and the national level scrum. It’s no coincidence that even flawed state exchanges are viewed more positively than the federal experiencewhile the overall polling shows the public still opposed to the law.

The real question for David Axelrod et al. isn’t whether the opponents are more mobilized than the beneficiaries (they clearly are, at least for this cycle) – or whether the opponents outnumber the beneficiaries (they clearly do, at least for this cycle). It’s whether the beneficiaries even view themselves as beneficiaries of Obamacare – or whether the political insulation from having TennCare or Kynect, designed to smooth implementation, leaves those who do gain subsidized coverage unaware that Obamacare had anything to do with it.

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