[A]ll these numbers are simply guesses. Really. That’s it. California’s numbers are guesses. Maryland’s numbers are guesses. Oregon’s numbers are guesses. Vermont’s numbers are just guesses. Everyone is just guessing. … We’re covering those guesses in the press. When they come in low, we say it’s good news for Obamacare. When they come in high, we say it’s bad news for Obamacare. But we don’t really know whether the guesses are right or wrong either.
Even more interesting is what happens in year two. By then, insurers will know who signed up and how much their care actually cost. But at that point, their pricing won’t really be up to them. The law’s medical loss ratio rules require insurers in the exchanges to spend at least 80 percent of premiums on actual health care. If the care costs less than that, insurers have to send consumers a rebate — something many have already had to do.
Aaron Carroll wonders if political maneuvering based on these “guesses” will come back to haunt Republicans actively opposed to implementation:
[T]he gambit of those opposing Obamacare seems to be a full throated and all-out-effort to show that Obamacare doesn’t work. The danger, though, is that it might.
The jury is still out, of course. But it’s important to recognize that full-out opposition to reform like this is somewhat novel in American politics. No one knows what such a strategy will bring in the long run.
Many thought passing the Affordable Care Act would be President Obama’s “Waterloo.” It wasn’t. In fact, some have argued that the flat out refusal to negotiate in the law’s passage cost opponents the chance to get a final product more to their liking. Things are shaping up similarly now. If, a year from now, it appears that exchanges are working out in states that embraced them, and that the Medicaid expansion is succeeding in states that allowed it, then it may turn out that refusing to bend may have instead caused the opposition to break.