Obamacare

Why Lack of Political Support is a Problem For Obamacare

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Whitehouse.gov

Over at The Washington Post, editorial writer Stephen Stromberg notes my current print-edition feature on the challenges ahead for Obamacare and the ways the administration has either exaggerated the health law's successes or downplayed its potential problems.

Stromberg argues that my piece is "ultimately too negative," but we do have a few points of agreement, mainly that "President Obama and his staff oversold the law, promising coverage expansion, cost containment, and unrealistic levels of consumer choice." In addition to laying out remaining problems for the law and noting the ways that the disastrous launch had helped shaped expectations for later performance, that was one of the major points of the piece: that even when the administration has reasonably good news or numbers on its side, it has often chosen to exaggerate its successes, and to declare them with more confidence than is warranted.

I want to zero in on a particular area of disagreement. Stromberg does not seem to think it is a particularly large problem for the law that it is still struggling in the court of public opinion. The law's low polls, he writes, say "little about its inherent merits."

I tend to think that bad polls are at least potentially a bigger problem. For one thing, poor popularity ratings suggest that even if one believes the law is a success, it's a success that's not widely felt. Its benefits are going either unnoticed or actively disliked by the majority of people, which, with a law the size and scope of Obamacare, indicates that it may not be as successful as intended.

More importantly, though, is that for a law to work—or even survive—it must maintain a certain level of political support, even and perhaps especially if you think, as I sense Stromberg does, that it's already a moderate policy success that just needs more time to work out the kinks. An unpopular law is an unstable law, and it is one that is constantly under threat of change or perhaps even outright repeal. 

Just as a general matter, it's hard to maintain a law when the party behind it loses elections because of it. That's probably what happened in 2010, when Democrats lost the House. A 2012 paper by a team of political scientists found that Democrats may have lost control of the lower chamber (and thus the ability to, say, tweak the law during key implementation years) as a result of voting for the health law. 

It's true that there's not perfect precedent for the total repeal of a law as sweeping as Obamacare. But major health reforms have been wiped from the books before. The Medicare Catastrophic Coverage Act, for example, was passed in 1988. A year and a half later, the law, commonly known as Cat Care, was repealed after extremely angry senior citizens refused to pay a tax financing an expansion of the health program's catastrophic coverage.

As a 1990 post-mortem of the law in Health Affairs said, "a retrenchment of this magnitude is unprecedented in postwar social welfare policy." It had never happened before, which meant that no one really thought it was possible. But it did happen. The public pressure was just too strong.

Do I think full repeal is a realistic threat to Obamacare? It does seem somewhat unlikely, especially since polls suggest that support for full repeal is smaller than support for changing the law. In any case, it would be somewhat unprecedented (Obamacare is much more sweeping than Cat Care was). But as the Cat Care incident shows, unlikely and unprecedented events do happen.

And full repeal is not the only plausible way that a lack of public support could affect Obamacare. A law does not have to be repealed to be changed, and some sort of revamp, whether through a series of smaller tweaks or in the context of a larger rethinking and reworking of the nation's entitlements, does seem quite possible.

Republicans have repeatedly stated their commitment to repealing or radically revamping Obamacare somehow. What they'll actually do if given power to make changes is less clear, but it seems unlikely that they will simply leave it as is. And since the launch of the exchanges last fall, we've even seen several Democrats, ostensibly the foundation of the law's political support, distancing themselves from the law and instead talking largely about "fixing" it. The party's own voters don't appear to be particularly motivated by the health law. 

If a law of this scale is to be judged as any sort of sustainable success, it will need to build broader political support—something it doesn't seem likely to gain when even representatives of the party behind it are implicitly describing it as broken.

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  1. “Do I think full repeal is a realistic threat to Obamacare? It does seem somewhat unlikely, especially since polls suggest that support for full repeal is smaller than support for changing the law.”

    It seems unlikely in the next two years while Obama is president. But it’s pretty easy to imagine a 2016 election that brings in a republican president and maintains republican control in congress. In that world, full repeal, or at least serious and sweeping changes, seems fairly likely.

    1. Agreed, I can not see any candidate winning the GOP nomination that won’t pledge to repeal and replace, and whatever happens at the Presidential level I think Congress will be GOP for a while

      1. The replace part it what scares me.

        1. Replace it with deregulation and free-market-oriented reforms.

          1. I agree. I just don’t think that’s what they mean.

    2. I imagine they will at least leave the state exchanges alone. If the federal exchange is actually functional, they will probably leave it alone as well. Most of the “reforms” will probably involve reducing requirements for employers, liberalizing insurance coverage requirements, and restricting subsidies to lower-tier plans. While they dislike the individual mandate, they would have to provide an alternate solution for the death spiral problem.

      1. It’s definitely up in the air now. A lot can happen in the next two years. The law could be massively successful, insurers could start lowering or keeping rates the same level, and the whole program could become really popular. Or insurers could see their claims spike, raise premiums, and get a bunch of bail-outs through the risk corridor program. Or SCOTUS could uphold Halbig and sweep the leg out from under the federal exchange. Or plenty of other scenarios. The point is, a number of plausible scenarios would tilt pressure toward repeal.

        1. Pigs can fly, Putin can respect borders, and Obamacare can be wildly successful.

          1. Indeed, wild success is not an option. The only possible level of success is “partial,” in the sense that some people will benefit from subsidies. But somebody benefited from those famous $600 toilet seats, too.

            1. Concentration of benefits and dispersal of costs. It’s what keeps the whole scam going.

      2. What will become of the 110 or so new Federal entities created by the law? Hoards of anonymous and unaccountable functionaries are quietly beavering away regulating health care into the shape progressives want. I see nothing stopping that.

      3. I disagree. They could go a long way by simply encapsulating the changes Obama has done via executive fiat. They could say, “Hey, we totally agree with Obama that the individual mandate should be shelved indefinitely.” Also, “We agree that the employer mandate is unworkable.” And “We agree that there should be no federal subsidies on the exchanges.” Just by agreeing with the changes the Dems have effectively put in place, they create a death spiral for the exchanges. The exchanges become a high risk pool for people who can afford insurance, but are otherwise uninsurable. I can live with that. I can’t live with the gigantic growth of medicare, but that’s a fix we put in place after stabilizing the insanity that has taken place over the last eight years.

    3. By 2017, full repeal might not even be necessary. It might just be a case of putting the remnants after court losses out of our misery.

      1. Exactly. A badly written bill that folds under its own weight.

    4. What seems likely to me is that republicans keep it in place (after all, it’s an expansion of federal power and they’re no less in love with power than the D’s) but will use it to their own advantage. Remember, it’s only unconstitutional at the time the other side does it, after your side gains power that it’s just another tool in the constitutional toolbox.

      1. That’s probably the outcome that scares the crap out of me. What’s scarier than the Democrat church lady coming after you to force you to admit you’re a racist because you’re eating a hamburger? The no nonsense always side with law enforcement conservative who enforces the idiotic law even though they know it’s idiotic and ridiculous.

  2. Lack of support might be a feature not a bug to the administration. They seem to be at least as interested in playing to current political polarization as they are to ‘doing something’ since they feel like the resulting political fights turn off many voters allowing their base to decide elections (at least Presidential ones), and an added benefit is they can always point to ‘obstructionism’ to escape the consequences of their rule .

  3. “It’s true that there’s not perfect precedent for the total repeal of a law as sweeping as Obamacare.”

    Prohibition?

    1. Even bigger. That was total repeal of a constitutional amendment, which takes some doing.

      1. And what was mostly responsible for that? Disobedience of the law on a massive scale.

      2. At that time we actually followed the constitution. The new prohibition was done using the ICA (created to prevent states from impeding interstate commerce) as justification.

        Under full color of the ICA the feds would be mandating that all states allow drugs to at least flow through their states even if their citizens weren’t allowed to purchase them.

  4. If the lack of precedent means that it can’t happen, then why is Suderman bothering with being a Libertarian, assuming that he is, since it would seem that unprecedented repeal of laws is the entire point of the ideology.

    1. Predicting what will happen =\= wishing what will?

      1. If it is not “realist”, why do it? At some point it become realistic or you are wasting your time.

        1. People work for world peace or to eradicate disease when they likely realize it won’t happen in their lifetimes or ever

          1. Big fucking deal.

        2. Because sometimes you need to tilt at windmills.

          1. THAT #$%&ING; WINDMILL HAD IT COMING!!!!

    2. But as the Cat Care incident shows, unlikely and unprecedented events do happen.

      Suderman says the exact opposite of what you are claiming.

  5. The National Recovery Administration was a law just as sweeping as Obamacare, if not more so, that was disappeared thankfully.

  6. Republican leadership doesn’t have the balls to repeal it, even with control of the House and Senate.

    “Stromberg argues that my piece is “ultimately too negative,””

    These people have massive blinders on. The law is a complete and utter fuck up that may end being gutted by the Supreme Court.

    1. gutted by the Supreme Court

      Don’t hold your breath

    2. They will never repeal it on their own. They will only repeal it when Democrats are willing to help. If the Democrats lose badly enough, there will be some of them willing to help and get out from under Obamacare.

      It comes down to elections. Unless until Obamacare hurts Democrats badly enough, it won’t be repealed. When it does, it will be.

      1. You’d have thought that the 2010 elections would have caused that message to penetrate their skulls.

  7. “It’s hard to maintain a law when the party behind it loses elections because of it.”

    Progressives will never accept this.

    If they lose because of ObamaCare, it won’t be because of ObamaCare. It’ll be because of the Koch Brothers, because of the racists, because of the homophobes, because of rednecks and white people, because of campaign spending,…

    When the progressives lose an election, it’s never the progressives or progressive policies that lose the election.

    Progressive Rule #1: The people want what we want.

    Progressive Rule #2: If the people don’t want what we want, see Rule #1.

    1. No Progs won’t. They didn’t accept the ass beating they received after Carter. But not every Democrat is a Prog. After 2000, the Progs took over the Democratic Party. If the Party loses badly enough, the rest of the party will get tired of losing and take it back from the progs. People always talk about reforming the Republicans. That is not good enough. We have to keep the Dems from being full retard.

      1. The Dems took 12 years to figure that out that Carter era policies were losers.

        1. Yes. But they did figure it out.

        2. 16. Billy Jeff was doing it, but it was getting hammered by Contract With America that moved the party.

      2. Just like the GOP got rid of the Religious Blight after 1996, 2008 and 2012.

        Oh, wait…no, they let the Religious Blight legitimately rape the election for them.

  8. “The law’s low polls, he writes, say “little about its inherent merits.” ”

    So, they just aren’t getting their message out effectively? People still don’t understand how wonderful they are.

    “I tend to think that bad polls are at least potentially a bigger problem. For one thing, poor popularity ratings suggest that even if one believes the law is a success, it’s a success that’s not widely felt”

    Heh, not widely felt. In other words despite it’s inherent wonderfulness no one is actually benefiting. I suspect that the definition for success the progs use is different than the one I use.

    1. I understand that perception is often different than reality. In the case of a bill sold as a way to improve people’s lives, however, the law’s low polls say a lot about its inherent merits. If the intended beneficiaries of the law don’t like it, the law is a failure.

  9. Of course it wasn’t going to be popular. Health policy was a great big “im ok, you’re ok” problem. Most people had insurance, most people who had insurance was pretty happy with it.

    So we had to colossally fuck up something that was generally working for everybody, to cover a few corner cases, and ram through narrow ideological ends.

    1. It was based on a lie. The health care system worked well for the vast majority of people. The Progs lied to themselves and the country and claimed that most people were not happy with their health care. People supported “change” because they thought it would change every else’ health care.

      1. I look back fondly on the HMO plan my family was in 5 years ago.

  10. With projected rate increases for 2015 pushing 60-75%, and the possible loss of policy credits through the Federal Exchanges, public opinion could swing very negative, very fast, this fall.
    If the GOP picks up the Senate, not just taking control with 51 votes, but adding a few more; plus any increase in the House, there will be the public support for repeal.
    With one thing and another hogging the headlines, it could get very ugly.

  11. right

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