Where Obamacare’s At

The costs have come in significantly lower than expected. Kevin Drum more or less declares victory:

Paul Krugman calls this part of Obamacare’s “life spiral.” In other words, it’s exactly the opposite of the dreaded death spiral that every conservative in the country has been banging the drum about for years. Basically, as good news accumulates, it breeds more good news. As Krugman puts it, success feeds success. And that’s true. The news about Obamacare has been almost uniformly positive for months. There are still plenty of small problems here and there—most of which could be solved if Republicans would allow it—and the refusal of so many red states to adopt Obamacare’s Medicaid expansion is truly a scandal. Nonetheless, it’s clear that Obamacare is basically a success. There’s nothing much that’s likely to change that now.

But Robert Laszewski, one of the sharpest Obamacare critics out there, hasn’t popped the champagne. He expected modest premium increases this year:

[T]he reinsurance program virtually protects the carrier from losing any money through 2016. I’ve actually had reports of actuarial consultants going around to the plans that failed to gain substantial market share suggesting they lower their rates in order to grab market share because they have nothing to lose with the now unlimited (the administration took the lid on payments off this summer) Obamacare reinsurance program covering their losses.

We won’t know what the real Obamacare rates will be until we see the 2017 rates––when there will be plenty of valid claim data and the Obamacare reinsurance program, now propping the rates up, will have ended.

Despite those concerns, Greg Sargent feels the politics of Obamacare shifting:

 Some misinterpret the suggestion of shifting health care politics as equivalent to claiming the law’s approval is rising or that it is becoming a winner for Dems. But that isn’t the argument. Straight approval/disapproval on the law has essentially remained unchanged for years — with some fluctuations around the botched rollout — and it remains a net negative for Dems that must be treated gingerly in red states. Those of us who argue the politics of the law are changing don’t mean to suggest otherwise.

Rather, the point is that the fading of negative headlines — combined with mounting enrollment — are shifting the ways candidates in both parties are talking about the law, potentially allowing Dems to mitigate the damage they might otherwise have sustained from it and to fight it out on other issues. There’s new evidence that this may be what’s happening. It’s now clear that the cooling passions over the issue are allowing Democrats more leeway to engage in debates over what is actually in the law, if not in debates over whether that thing called “Obamacare” is good or bad.

Suderman detects “a convergence of sorts, and also a kind of wary standoff, in which both parties are grappling with the fact that Obamacare is unpopular, but also that millions of people are now receiving its benefits”:

[I]t’s at least possible to imagine that the current convergence continues, and eventually results in a melding of the two party’s stances, leaving much of Obamacare’s basic infrastructure, including the exchanges, in place but altering them substantially and using them, in a kind of ju-jitsu move, as a vehicle to reform the rest of the entitlement system, which is ultimately a much bigger fiscal problem. That’s essentially what the Manhattan Institute’s Avik Roy has proposed in his recent health entitlement overhaulplan, which would deregulate the exchanges, end the individual mandate, transition Medicaid and Medicare to the exchanges, and, according to one estimate, could expand coverage even more than Obamacare.

The danger with that sort of plan is that no one will like it—that Republicans will see it as a concession to Obamacare, and Democrats as a fundamental attack on entitlements. Certainly it’s not something that the base on either side is willing to accept right now. But it’s also the sort of clever compromise that could eventually find backers on both sides of the aisle, especially as Obamacare settles in further.