How Obamacare Will Reshape American Politics

The last two days have apparently seen a surge in ACA enrollments on – in two days as many new Obamacare beneficiaries as in the whole of October. David Corn sees Obamacare’s introduction as make or break for both parties:

[W]ithin months, it may well be that abstract arguments over the nature of Obamacare will be trumped by the realities of the Affordable Care Act. Eventually, there will be stats and facts to consider: how many people receive insurance through the exchanges, what happens with premiums, the direction of health care costs, customer satisfaction, and the like. Though the results may be open to debate for a while, it is distinctly possible that one side or the other will be proven right (or wrong). If the website functions, President Obama Visits Boston To Talk About Health Caremillions sign up, and the health care market doesn’t crash, and premiums don’t zoom up—and this will be on top of the already existing benefits of Obamacare, including removing preexisting conditions restraints, allowing young adults to remain on their parents’ policies, reducing out-of-pocket prescription drug costs for seniors, and forcing insurance companies to devote a higher percentage of premiums to health care coverage—where will the Republicans be? Not only will they be failed doomsayers; they will have lost the No. 1 item on their why-you-should-vote-GOP list. Their anti-government crusade will be derailed. They will be a train without a motor.

Should Obamacare not work, then Obama’s vision—which reflects the progressive tradition of the past century—will be a flat tire. He will no longer be able to advance the cause of government activism. Expand Head Start? Create an infrastructure bank? Why should government be allowed (or trusted) to increase its reach? He can talk about helping the middle class. But how? The failed rollout of the website was a problem in so many ways but especially because it suggested that government cannot perform competently. A more extensive failure with Obamacare would suggest that government cannot be used in the manner Obama wishes to see it utilized.

What’s at stake in this never-ending debate over Obamacare are the foundational premises of each party. The success of Obamacare could be close to a death blow to the GOP. Ditto for Obamacare and the Democrats, should it collapse.

Yes and no. I don’t really want to see government expand from its current size and cost and ambition. I’m not a progressive and backed Obama because of his pragmatism. The reason I support the ACA is partly moral – if I can’t in good conscience employ anyone without health insurance, I can’t in good conscience acquiesce to a system that leaves millions out in the cold; part fiscal – I don’t believe in free-riding and see the need to reform a system that has close to no effective cost controls; and part because of all the possible proposals to end the cruelties of the past – bankrupting people with pre-existing conditions, yanking insurance from people just when they need it – Obamacare squares the most circles. So I wouldn’t mind very much if Obamacare both addressed these core problems better than the past and nonetheless prevented liberalism from going after any more lofty progressive objectives. In fact, that would be my ideal result. But, of course, I may be a parish of one again.

Drum, for his part, is optimistic for his side:

By the middle of 2014, Obamacare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown. People with employer health care will still have it and very few will notice even a minor change in their normal routine.

Given all this, it’s hard to see Obamacare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. Obamacare’s taxes don’t touch anyone with an income less than $200,000. Aside from the tea partiers who object on the usual abstract grounds that Obamacare is a liberty-crushing Stalinesque takeover of the medical industry, it’s going to be hard to gin up a huge amount of opposition. And that’s doubly true since, as Sargent says, the Republican Party will have no credible alternative for a benefit that lots of people will already be getting.

Bernstein expects Obamacare to eventually fade away as an issue:

That doesn’t mean that health care won’t be an issue. Expect, for example, Republicans to eventually fight over subsidy levels (and, perhaps, both parties to try to refashion subsidies to avoid perverse incentives on earnings). Expect, too, Republicans to eventually try to reduce ACA-connected taxes. There’s been some of that, but so far it’s mostly been restricted to things that could be outright repealed. Expect, too, plenty of oversight by this and future Congresses over all phases of it. After all, there’s more to oversee now.

The point is that even as the debate about “Obamacare” eventually fades away, we shouldn’t expect health care to vanish as an issue. Indeed: expect it to be more central to U.S. politics going forward.