Obamacare’s defenders are doing their best to sustain a triumphant mood these days. In the wake of the late-March surge in exchange enrollment, many proponents of the law have insisted it can no longer be rolled back. As the president put it in his April 1 Mission Accomplished speech announcing the enrollment figures, “The Affordable Care Act is here to stay.”
But just as conservative assertions that the law would collapse of its own weight were premature, so too are today’s liberal proclamations that the debate is over.
Clear-eyed opponents of Obamacare have long understood that once the Supreme Court upheld the law’s individual mandate and President Obama secured reelection in 2012, it was going to be extremely difficult to unwind Obamacare before 2017. The replacement of Obamacare is going to require a sustained political effort.
But its defense is going to require a grueling effort from the left as well, and the president’s insistence that the willingness of 2 percent of the population to enroll in public exchanges means the debate about Obamacare’s viability is over suggests he understands how challenging that effort will be. The enrollment figures mean Obamacare has survived the self-inflicted wounds it suffered from the government’s disastrous website design and implementation failures, but it hardly speaks to the law’s more profound structural problems—which have always been the actual subjects of the debate the president wants to foreclose.
The past six months have taught us that the federal government can’t even design a website properly, and that the kinds of private-sector experts called in to rescue the exchanges from their near-death experience are capable of impressive feats of resuscitation and redesign. Both of those lessons have something to tell us about where American health care should be going, and it’s not what the law’s champions would like to hear.
More important, these early months of implementation have made Obamacare’s flaws clearer to the electorate. The president said the middle class would share in the benefits of his reform plan, with lower costs and more secure coverage. Instead, millions of middle-class families have lost the insurance plans they liked and are now paying higher premiums for coverage they consider inferior. Large and small employers are making adjustments in their plans in response to Obamacare’s taxes and regulatory requirements and are passing the higher costs on to workers in the form of greater cost-sharing and reduced access to care.
It is far from clear that the 8 million or so enrollees in Obamacare’s exchange plans are happy to be there. Some were forced into these exchanges because their plans were canceled, and many others signed up for coverage despite the fact that they find their options unattractive. The truth is that Obamacare is pushing Americans into accepting its bureaucratic constraints through taxes and regulations, including the tax on remaining uninsured.
We should not be surprised that this kind of pressure can push people into signing up. But we should also not be surprised that it offends many Americans who resent being shoved into a government-restricted marketplace. And it seems likely that many more families will find themselves facing displacement, uncertainty, and unattractive options as many small businesses lose their pre-Obamacare coverage this fall and are forced to either spend more or end their employee coverage.
The lawless machinations used to temporarily delay the effects of some of these blows may soften the political pain for Democrats a little for now, and the transformation of Obamacare’s “risk corridor” provision into a slush fund for payoffs to insurers to keep them cooperative may put off some of the trouble too, but both can only do so much. Voters see what’s happening and consistently register their displeasure in opinion polls.
The awakening among voters to Obamacare’s unpleasant realities has created a historic opportunity for the law’s opponents. Citizens are experiencing firsthand the effects of the growth of the liberal welfare state, and most don’t like what they see. This puts them in a frame of mind to consider viable, practical alternatives. Conservatives must not miss this once-in-a-generation opportunity to present the public with a genuine alternative on health care—and thus also with a vision for reforming government more generally.