In a post linked to earlier, Douthat noted that the Obamcare “subsidy cut-off creates a chasm between winners and losers right in the middle of the middle class, which is not a normal way for social insurance to be subsidized”:
Now an effective levy of several thousand dollars on the small fraction of middle class Americans who buy on the individual market is not history’s great injustice. But neither does it seem like the soundest or most politically stable public policy arrangement.
Ezra imagines various ways the law could develop. One scenario:
The law could fail relative to expectations and prove a political disaster for Democrats, but still be delivering insurance to more than 10 million Americans come 2017. As a result, President Chris Christie could find himself with a mandate to make changes but no earthly way to pass full repeal. Obamacare thus becomes the platform for a far-reaching set of Republican health-care reforms.
Cowen foresees something similar:
Chris Christie will campaign against ACA and beat Hillary Clinton in the general election. Upon assuming office he will place price controls on the insurance plans in the individual market, repeal much but not all of the federal financial support for the Medicaid expansion, and keep many other parts of ACA, while claiming to have repealed the whole thing. Enough Democrats will go along with this, as public opinion will have shifted toward the Republican side on this issue. The individual market still won’t be working very well. The exchanges will be working fine in the technical sense, but skittishness, political risk, and the adverse selection death spiral will have led the insurance companies to withhold high quality policies from that side of the market.
Meanwhile, McArdle wonders whether the limited networks many exchange plans use will face a political backlash:
Nineteen million people were buying insurance on the individual market; an estimated 16 million of them will need to switch to policies on the exchanges or Medicaid. Those policies may end up costing them less, after subsidies (especially if they go on Medicaid). But they will also force them to go to cheaper doctors and hospitals. The young won’t care, but the middle-aged will chafe at the loss of freedom. Especially because the expensive doctors and hospitals are often the ones most in demand — the ones with cutting-edge technologies and skills. Cost is not a perfect proxy for quality, of course. But it is not unrelated, either.
Now, maybe that’s all they do: chafe and complain. But maybe they contact their state or federal legislators and demand that carriers be required to cover all the expensive doctors and hospitals. This is basically what happened in the 1990s: Health maintenance organizations achieved significant cost controls by limiting patient choices, and patients got their legislators to put a stop to it. With so many people being affected, it would be surprising if that didn’t happen again.
The Dish 