Obamacare

Obama's Victory on Obamacare May Be Short Lived

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Whitehouse.gov

In a speech on the White House lawn yesterday, President Obama essentially declared victory on Obamacare. But this victory will be tough to sustain.

Going forward, the law presents major challenges for the president and his party. Although conservatives played a role in generating some of its core ideas, the law in its final form is a strictly Democratic creation—written, passed, and implemented by a single party. In passing the law, and in billing it as an all-things-to-everyone transformation of the entire health system, Democrats shackled themselves not only to the law's specific fortunes, but to the fortunes of the entire American health system. Democrats own health care in America now, and all of its problems with it.

The foremost of these problems is rising costs. There are two ways to think about health care costs: One is at the national level; the other is at the individual level. At the national level, Obamacare's supporters frequently note that health care cost growth has slowed dramatically since President Obama took office; therefore, Obamacare's various payment reforms must be the cause. (President Obama referenced this idea in his speech yesterday.)

This claim is highly contested. It's true that the growth of health spending has slowed, but the slowdown started long before Obamacare took effect. And the additional post-Obamacare slowdown likely has much more to do with the recession than with the early effects of any of Obamacare's supposed cost-savers. That's the conclusion of analysts at the Kaiser Family Foundation, as well as the actuaries at the Centers for Medicare and Medicaid Services. It's possible this could change in the future, but it's far too early to give Obamacare credit.

Either way, this argument only goes so far. When most Americans hear about health care's rising costs, they're not thinking about the rate of growth of national health expenditures. They're thinking about their own pocketbooks and bank accounts. How much does health care cost them, personally, in terms of premiums and out-of-pocket spending?

Obamacare's supporters have a number of go-to responses when this issue comes up. Like President Obama in his speech yesterday, they often tell personal stories of individuals whose premiums were reduced under the law, making the point that in some cases, premiums will go down. But those individual stories usually come with an admission that, on average, premium costs will continue to rise even as the health law settles into place. However, the argument usually continues, premiums will rise at a slower rate than before the law was in place. "Premiums are still rising for families who have insurance," President Obama said yesterday. "But, so far, those premiums have risen more slowly since the Affordable Care Act passed than at any time in the past 50 years." 

Whitehouse.gov

There are two problems with the line of argument. The first is that rising premiums—whether they're rising slower or not—aren't what was promised. Not only did the president specifically promise on the campaign trail that his health care reform plan would lower premiums for families by $2,500 on average; the White House repeatedly touted lower premiums for families as a primary feature of the law. "Objective analysis shows reform will help small businesses, lower premiums for American families," reads the headline of a November 2009 post at the White House blog. "CBO confirms families will save money under health reform," reads another. CBO's analysis, the post notes, didn't even account for the health law's "measures to control costs…so if anything it understates the positive impacts of reform." Americans were not promised a law that slowed the rise of premiums. They were promised a law that would lower premiums and save them money.

The second problem is that, at least in the individual market that Obamacare affects most directly, we don't even know what premiums will look like next year, or the year after that. Insurers have to submit next year's rates in the next few months, and in some cases, because so many people signed up at the last minute, they will have to do so with very little actuarial data on the health status of those getting insurance through the exchanges. Rates are going to go up. It's possible, as insurers have already quietly warned, that they might go up by a lot.

If that happens, it will be Democrats' problem.

Cost isn't the only issue that Democrats will have to contend with either.

There's also the issue of access. About 70 percent of plans offered through the law are tightly restricted, narrow networks, according to a McKinsey & Co. study. That's going to be an issue. When people with individual insurance, or Medicaid, can't see the doctors they want to see, or visit the top hospital for their disease, or can't get the procedures or drugs they want because it's not covered by their plan, or because reimbursement rates are low, that's going to be a problem for Democrats too. We're already seeing early rumbles to this effect.

To some extent, the health law's supporters will be able to divert blame onto insurance companies. But that won't work as well as it used to, because Democrats are now effectively partners with the insurance industry in the operation of the health law, and because President Obama promised that no one would lose access to a provider he or she liked. Blame that used to fall squarely on health plans will now be spread amongst the political architects of the health law as well.

The administration is already aware of this problem and has proposed rules to mitigate it by limiting the options for health plans seeking to create narrow network plans. But it's not that easy. Narrow network plans flourished on the exchanges because they are cheaper. Broader provider networks will mean higher costs. Balancing between the two in a way that is sustainable, effective, and broadly popular will be extremely difficult.

These are difficult health policy problems. They are also significant political problems. The health law has never been popular, and it is dragging down Democrats' prospects at the polls this November. Improving Obamacare's design will be difficult for even the most committed technocrat under any circumstances. But Democrats will have to do it while fighting to maintaining the legislative—and, come 2016, administrative—control necessary to steer it in their preferred direction. 

Thanks to the administration's numerous executive tweaks and patches, we've already had a taste of what that will probably be like: changes made for short-term political gain that undermine the law's longer-term prospects.

All this will take place against the backdrop of a broader sense that with Obamacare, Democrats were supposed to have fixed the major problems with the American health system. President Obama pushed back against this notion yesterday, cautioning that the success of the law "doesn't mean that all the problems in health care have been fixed forever." That he felt the need to try to temper expectations suggests that he knows that those expectations are impossibly high. 

When building Obamacare, liberal health wonks often referred to the law's design as a "three-legged stool"—regulations, subsidies, and a mandate. With Obamacare's design phase over, and its upkeep and adjustment period just beginning, Democrats will have to try to find a way to balance between a different trio of concerns: cost, access, and political viability.  It's the three-legged stool of Obamacare maintenance—and it may be harder to support than Democrats expect.

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  1. The foremost of these problems is rising costs.

    Again, the democrats don’t care a whit about the rising costs of health care. To a leftist, something is free if someone else is paying for it.

    1. This will be flipped into “if you don’t want to spend $$ on healthcare, you don’t care about children” – how much cost control do you see in govt education programs?

      1. If you are young and healthy and won’t buy over priced health insurance, you just don’t care about America Johnny.

      2. I’ve been told numerous times that I’m irresponsible for doing without health insurance after telling someone that my old policy was canceled and I won’t get one of the shitty exchange policies. Bitch, I HAD insurance. Fuck.

      3. I’ve been told numerous times that I’m irresponsible for doing without health insurance after telling someone that my old policy was canceled and I won’t get one of the shitty exchange policies. Bitch, I HAD insurance. Fuck.

        1. Dammit. I even checked twice to make sure the first one hadn’t gone through. Why can’t this shit be done at 3 am instead of 3 pm?

        2. It was worth reading twice.

          1. And again.

    2. yep! the world owes me a living – entitlement mentality is what is taking this country down…

    3. “If you think healthcare is expensive NOW, just wait ’til it’s FREE”
      ~P.J. O’Rourke

  2. Look Sudderman, tractor production exceeded the goal set in the five year plan. Dear leader told us as much. You only continue to debate these facts because you are a wrecker and imperialist stooge.

    1. And you are a capitalist lackey too.

      1. And a petit-burgeois deviator.

  3. Better alt-text: “Mission Accomplished”.

  4. This whole thing is so absurd. The law is a disaster for a whole slew of reasons, perhaps the very least of which is that the on-line platform for the plans sucks.

    1. This.

      The fundamental libertarian critique isn’t that it won’t enroll enough people, its that the more people it enrolls the more it will suck.

  5. Video: Fallon rips ObamaCare victory lap by White House
    …After Barack Obama took a victory lap with the announcement of 7.1 million enrollments through the system by its March 31st deadline, Fallon responded by noting that “it’s amazing what you can achieve when you make something mandatory, and fine people if they don’t do it ? and keep extending the deadline for months”…

    1. BURN!!

      Way to go Jimmy. I didn’t think you had it in you.

    2. You know, as much fun as people made of Bush and the “Mission Accomplished,” at least the military actually toppled the Iraqi government. Obama’s current victory lap is for, well, nothing at all. Nothing whatsoever has changed–the law is one of the worst in a very long time, and perhaps among the most financially destructive ever.

      1. And it wasn’t even Bush’s sign. It was the ship’s sign and it meant “their mission was accomplished” not the whole war. Bush never said “mission accomplished”. But why would we ever let the facts get in the way of a good myth.

        Obama in contrast isn’t just standing in front of a misplaced sign. He is saying “mission accomplished”. Of course a year from now when it is undeniable what a lie that is, he court media will deny he ever said such a thing.

        1. Without getting into the who did what argument, the fact is that there was something real to that statement, whoever made it, even granting that whether we ever accomplished our (or even had a clear) mission is a subject for another time.

          That said, Obama is really exposing his love for the Big Lie here. Nobody is buying this, even the minions who are taking up the TOTAL SUCCESS HAS BEEN ACHIEVED banner, and the law’s incredible failures remain intact.

          1. We had accomplished at least one mission, toppling the government.

            This in contrast really is Dear Leader telling us that tractor production has exceeded the five year plan, facts be damned.

            It is a testament to the epic dishonesty and cravenness of the media that he isn’t being laughed out of office for this.

          2. No, you see his mission has been achieved. The mission isn’t the things he said the law was ostensibly designed to do (lower costs, improve access, guarantee care). The mission was to subsidize enough of the largesse to create a sizable enough constituency that will continually vote to entrench and expand the government’s role in the medical industry. 7 million enrollees was just the threshold point he felt was needed to justify that.

            Of course he doesn’t realize that many of those 7 million would prefer what they had before, but that’s a function of his own vain solipsism and inability to relate to humans other than himself. But those who do not comply will be PENALTAXED into submission.

          3. Actually, it kind of reminds me of when he was telling everyone in 2010 about how truly great the economy was. At least he finally figured out that no one believed that crap. This nonsense he seems to think he can will into our psyche. It scares me to believe it works on liberals. How dumb are these people?

            1. It is for consumption of the media. I have seen not a peep out of my proggie friends about this. I suspect even they know how fucked Obamacare is. They are going to get crushed in 2014, and once the employer mandate takes hold, watch out !

              1. Don’t count chickens or electoral waves before they hatch. Any number of things could save the Democrats in the Midterm – great earthquakes, nuclear war with Russia, financial crashes, even a supervolcano.

        2. Isn’t that SOP for these guys? Shamelessly tell bald-faced lies on camera to get past a hurdle, then get back on camera and deny they ever said it?

          1. Yes. That and lie until something is undeniable and then say it doesn’t matter because it is “old news”.

            1. At this point, what difference does it make?

          2. I keep wondering if the media will ever check his numbers. Last Wednesday, they passed 6 mill. Are you trying to tell me that a million, plus, people signed on in four days? Bull.

    3. O: “If I’ve lost The Tonight Show I’ve lost Middle America”

    4. Did he slowjam that?

    5. He forgot: “If you force insurance companies to kick people off their existing plans.”

      Funny how the 15 million who were potentially going to lose their insurance in the individual markets were “a tiny sliver,” yet the 7.1 million (minus 20 percent who haven’t actually paid premiums + 6 million who got kicked off their old policies + a large number who were always eligible for Medicaid but had never signed up) if a BIG FUCKING DEAL.

      It would all be depressing if American voters weren’t capable of sorting this all out and taking corrective action

  6. It’s possible, as insurers have already quietly warned, that they might go up by a lot.

    If that happens, it will be Democrats’ problem.

    I’m sure the DemOp media will correct this unmutual thinking by pointing out that Obama isn’t raising rates, EVIL RETHUGLIKKKAN CORPORATIONS ARE!

    1. It’s simple really, if rates go down that’s because of Obamacare. If rates go up, it’s because of Republican opposition combined with greedy insurance corporations.

    2. Yes, and the insurance companies did themselves no long-term favors getting in bed with the Democrats and their law to end all laws.

      1. I’d bet some of them got in bed by Gun point.

      2. I imagine the promise of Too-Big-To-Fail Status was pretty enticing.

    3. The administration will secretly indemnify them from loss if they keep the rates low. The law has a guarantee for insurance companies. Right?

  7. The Sovietization of America proceeds apace.

    1. And it will end the same way.

      1. No CIA officer is as competent a strong-man as Putin.

  8. In what sense is 7 million out of 30 million a victory?

    1. It’s worse than that – two large parts of that 7 million is first,the people that HAD insurance in the first place, but lost it to ObamaDoesntCare, and second, people who were medicare elgible anyways.

      1. And you have to cut 7M down to 5.6M to account for the sign-ups that aren’t actually enrolled due to non-payment.

  9. In a speech on the White House lawn yesterday, President Obama essentially declared victory on Obamacare, AKA the war on healthcare.

    FIFY

  10. Start working at home with Google! It’s by-far the best job I’ve had. Last Wednesday I got a brand new BMW since getting a check for $6474 this – 4 weeks past. I began this 8-months ago and immediately was bringing home at least $77 per hour. I work through this link, go to tech tab for work detail
    ?????
    ?????????????? ? w?w?w.?w?o?rk?b?a?rr.c?o??m

    1. New BMWs suck. Don’t the bots read the morning links?

      1. audi is the new beemer

  11. Does not matter.
    Whatever number ends up in whatever metric, Obo will move the goal posts to it and declare success!
    And Obots like our resident slimy turd will shout and cheer!

    1. Sevo

      Another great comment. Keep up the good work. I can hardly wait to read your next brilliant literary masterpiece.

  12. You know who else had a short lived victory?

    1. Beef Supreme?

    2. Field Marshals Ludendorff and Hindenburg?

    3. “My mom”

  13. The media is trying really hard to paint this as proof of the glory of Obamacare. proof

  14. – Does the ACA reduce healthcare costs for the average American family? No.

    – Does the ACA do anything to improve *access to care* (i.e. making treatment more widely accessible and encourage more services to expand)? No.

    – Has the ACA offered significant benefits to the ~30-40m uninsured in the US, and done anything to solve the so-called ‘coverage gap’? No.

    until anyone can show the answers to any of the above is, “Yes, and here’s why”, the law is an abysmal failure. The pretend-event of hitting ‘look, 7m people went to our website! Yay!’ is just an attempt to quash media commentary. which is why the comment, “The Debate is Over” was so prominently featured.

    1. You forgot being deficit neutral. That was a biggie for me. Obamacare is a prime example of what happens with many government programs. Generally, you can predict that the cost of some government program will be around double or more what the pols say. That is exactly what happened with Obamacare, and that is exactly one major thing people should take away from this experience. Unfortunately, that’s not happening.

      1. They couldn’t have passed it via reconciliation had it not been qualified and certified as “deficit neutral”.

        1. Could they be sued because of that? The law was passed through reconciliation which has certain requirements. After the law is passed, if a significant portion of those requirements are not met by the law, or if executive action effectively changes the law to the point where it no longer meets the reconciliation requirements, shouldn’t it be considered null and void?

          1. You should be able to, but no. The court would just say you don’t have standing and that it is a political question. If the Congress won’t live by its own rules, your remedy is the ballot box.

            Not saying that is the right answer but that is the answer you would get.

  15. “Premiums are still rising for families who have insurance,” President Obama said yesterday. “But, so far, those premiums have risen more slowly since the Affordable Care Act passed than at any time in the past 50 years.”
    .
    That’s bullshit. I worked as a health insurance underwriter, and some years premiums stayed the same, and one year they dropped by 10%.

      1. ???? Where have all the Kulaks gone, long time passing?

        Where have all the Kulaks gone, a long, long time ago?

        Where have all the Kulaks gone – starved by commies every one.

        When will they ever learn?

        When will they ever learn? ????

    1. Staying the same and dropping aren’t the same as “rising more slowly”.

  16. “Democrats own health care in America now, and all of its problems with it.”

    Baaahahahahaha…..oh Peter, you kidder! As if the press in this country would ever remove their collective tongues from Chocolate Nixon’s ass long enough to hold the Democratic Party responsible for anything.

    1. I was wondering if he was kidding or just undeniably naive to think that.

  17. ‘MISSION ACCOMPLISHED’

  18. “Democrats own health care in America now.”

    No they don’t. They can always blame something else, including the free market, no matter how many times they screw it up. They’ve always done it this way. Why would it stop here?

  19. “But, so far, those premiums have risen more slowly since the Affordable Care Act passed than at any time in the past 50 years.”

    That makes no sense.

    To me anyway.

  20. Republicans will probably keep the House and get control of the Senate in 2014 and, by 2016, the entire fiasco will be their fault.

    1. Why not? You don’t expect them to repeal this monstrosity do you?

      1. Hell no, they’ll be to busy stabbing each other for this new found Power.

  21. SCOTUS could shut down all federal subsidies in one of the cases in front of them. That would be the most hilarious thing to me. Fingers crossed.

    1. I think you’ll get your fingers broken… unfortunately.

      1. On the whole, it’s the only logical outcome. And, yes, that’s what I said before the convoluted mandate decision, so my record’s not so good…

  22. Obamacare is the stupidest law ever.

    1. No, that distinction goes to Nixon’s wage and price controls. He knew it wouldn’t work and foolishly did it anyway for political reasons.

  23. And we haven’t gotten to the employer mandate yet.

    Although of course when companies start canceling bennies, the Democrats can spread the blame to greedy corporations.

  24. The Reagan/Obamaphone program has somewhere around 13+ million phone users, so it seems that program is more successful than Obamacare. Folks will sign up for “free” stuff, just as they would rob a bank if the government declared bank robbery legal.

    Hey look, were giving away free shit, hurry up and log on our website and sign up to get your free shit paid for by other people’s money!!!!!

    Look honey, we can rob and not even face consequences or go to jail!!??? Lets do it!!! Yeah that’s right, we’ve got ours and you lost yours! Look at us robbing you! Hahaha. (While standing behind the police) Touch us and we’ll have you locked up and well sue!

    Oh and look at the little instruction card we can print out. It says ” If anyone opposes the healthcare law, just call them heartless racists”.
    ——
    This is why government is insanity. How in the hell can folks come up with this crap and not expect anyone to realize how really stupid such policies and programs are, and that folks are being blatantly robbed in the process??? I know many of us know……but effing sheisser!!!!!!

  25. Only two things matter re ACA:

    1. Will the Senate have a GOP majority starting in 2015 or 2017?

    2. Who will succeed Obama as POTUS?

    Everything else is self-congratulation and puffery, passed off as sound bites.

    1. Even the puffer fish is tired of all the puffery going on. That was until…..my friend ate it.

  26. I especially liked this part…
    “Not only did the president specifically promise on the campaign trail that his health care reform plan would lower premiums for families by $2,500 on average;”…

    Reminds me of the story of the mathematician who drowned while crossing a river that averaged just one inch depth of water…

  27. Employers feel it will cost $5K per employee more. So that will kill employment or employers will boot employees off their insurance. There is no victory here. Just larger costs. All the promises were lies. No $2500 per family savings, it will hit the deficit big time, you can’t keep your plan, doctors or hospitals, you will pay more for coverage unless you get a subsidy, prices for insurance for all will rise, and the uninsured will still be uninsured. The whole law was a lie by Obama and the Dems.

  28. The fact that Obama and his Dem cronies would stand up and publicly declare victory based on a number which is, a best, a mistruth, shows that Obama and Obamacare supporters aren’t concerned about insuring the uninsured or lowering costs. Since they are celebrating the success of Obamacare, and the stated goals haven’t been successes, then what successes are they celebrating? The only successes that Obamacare has had. More control over the health care and health insurance industries and thus major parts of people’s lives.

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