Retiring Sen. Tom Harkin, the Iowa Democrat and chair of the Senate Health, Education, Labor and Pensions Committee, which did much of the heavy lifting on early drafts of Obamacare, now thinks that passing the law in its current form was a mistake.
The system created by the law "is complex, convoluted, needs probably some corrections and still rewards the insurance companies extensively," he told The Hill. "We had the power to do it in a way that would have simplified healthcare, made it more efficient and made it less costly and we didn't do it. So I look back and say we should have either done it the correct way or not done anything at all."
What would have been the "correct" way? Single payer, Harkin said, or at least the inclusion of a government-run insurance plan—widely known as a public option. Harkin tells The Hill that when Democrats controlled both chambers of Congress in 2009 and 2010, they had the votes necessary to pass those plans into law.
In some sense, this is just a revisionist liberal fantasy. Obamacare passed in the complex, insurance-industry friendly form it passed in because it was the only form that could secure enough votes, and even then it only barely made it over the finish line. Moderate Democrats were deeply concerned about the possibility of appearing to support a government takeover of the insurance industry, which a single-payer plan would have done, and which a public option would have taken a step toward. The health care industry groups—doctors and hospitals and insurers—whose support the White House believed was critical to passing the law would not have backed any such plan. Instead, they would have spent hundreds of millions loudly opposing it. Obamacare was either going to pass in a form that looked essentially like the one it passed in, or it was not going to pass at all.
Yet Harkin's comments also suggest a dawning realization on the part of at least some Democrats that the health law has created significant political problems for the party. Harkin isn't the first prominent Democratic legislator to express regrets about the timing and construction of the law in recent weeks. At a National Press Club appearance last week, Sen. Chuck Schumer (D-NY), also complained about prioritizing the health care law in 2009. Democrats "blew the opportunity" they had when they held complete control of Congress and "put all of our focus on the wrong problem—health care reform," he said.
Keying off of Schumer's remarks, New York Times opinion contributor Thomas Edsall looks at the ongoing political fallout from the health care law. Polling data has consistently shown that more of the public opposes the law than supports it, and in the months since the major coverage expansion kicked in, more people now say that the law is making things worse for themselves and their families. Of the 60 Democratic senators who voted for the law, 28 are now out of office. There's historical precedent for all this too. Edsall notes that the failed attempt to pass also produced political fallout for Democrats, who saw mass defections of middle class white voters and seniors in the aftermath.
Edsall also points to a column by political analyst Charlie Cook, who argues that Obamacare is the defining feature of the current Democratic party. The law has "framed where the Democratic party is," according to Cook. Judging by the results of last month's midterm election, it has not framed the party in ways that are politically beneficial. And party members know it: a majority of the Democratic House candidates on the ballot this year did not express clear support for the law.
Much of the Democratic party still stands behind Obamacare, of course, though they tend to defend it as a policy victory rather than on a political win. Democratic House Minority Leader Nancy Pelosi's response to Schumer: "We came here to do a job, not keep a job." That's an implicit admission that the politics of the law are not so good.
Even Democrats who believe the political hit is worth the policy gain should be concerned: It will be harder to maintain the law without political victories to continue supporting it, especially if it keeps underperforming. No, the law has not imploded or collapsed under its own weight, but its rollout was not smooth, and enrollment in insurance is now projected to go at a notably slower pace than originally expected for the next several years.
The complexities of the law that Harkin complained about, and the corrections he says are needed, make the ongoing task of managing the law even more challenging. Witness the headaches caused by the administration's decision to auto-renew health plans for those covered through the exchanges: The move will bolster enrollment numbers, but is also likely to leave many enrollees in plans with premiums that rise sharply and unexpectedly. That possibility has in turn given rise to proposals for even more drastic and potentially disruptive technical tweaks.
None of this is likely to make the law more popular with the broader public, which will in turn make it even harder to sustain politically. Indeed, compared with the years prior to President Obama's election, the American public is now significantly less likely to say that it is the job of the federal government to ensure that all Americans have health coverage. According to Gallup, support for the federal government ensuring health coverage generally hovered around or above 60 percent throughout the Bush administration, rising to a peak of 69 percent in 2006. But since 2009, a majority of the public has said that coverage is not a government responsibility. The percentage who believe it's not the government's job rose from 2010 through 2013, hitting 56 percent, but has dropped back somewhat in the last year. But the numbers are still strikingly different from where they were less than a decade ago, with 52 percent saying it's not the federal government's job to ensure coverage; only 45 percent say it is.
In the age of Obamacare, it's not merely that Americans have lost interest in this particular health law. They've lost interest in the larger project of government-managed universal coverage. Which suggests that Harkin may be half right in his political analysis, and too hopeful, even in his regret: Yes, it was a mistake to pass Obamacare as it is—but it may have been a mistake to pass it any form.
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