Over at The Washington Post,
editorial writer Stephen Stromberg notes my
current print-edition feature on the challenges ahead for
Obamacare and the ways the administration has either
exaggerated the health law’s successes or downplayed its potential
problems.
Stromberg argues that my piece is “ultimately too negative,” but
we do have a few points of agreement, mainly that “President Obama
and his staff oversold the law, promising coverage expansion, cost
containment, and unrealistic levels of consumer choice.” In
addition to laying out remaining problems for the law and noting
the ways that the disastrous launch had helped shaped expectations
for later performance, that was one of the major points of the
piece: that even when the administration has reasonably good news
or numbers on its side, it has often chosen to exaggerate its
successes, and to declare them with more confidence than is
warranted.
I want to zero in on a particular area of disagreement.
Stromberg does not seem to think it is a particularly large problem
for the law that it is still struggling in the court of public
opinion. The law’s low polls, he writes, say “little about its
inherent merits.”
I tend to think that bad polls are at least potentially a bigger
problem. For one thing, poor popularity ratings suggest that even
if one believes the law is a success, it’s a success that’s not
widely felt. Its benefits are going either unnoticed or actively
disliked by the majority of people, which, with a law the size and
scope of Obamacare, indicates that it may not be as successful as
intended.
More importantly, though, is that for a law to work—or even
survive—it must maintain a certain level of political support. An
unpopular law is an unstable law, and it is one that is constantly
under threat of change or perhaps even outright repeal.
Just as a general matter, it’s hard to maintain a law when the
party behind it loses elections because of it. That’s probably what
happened in 2010, when Democrats lost the House. A 2012 paper by
a team of political scientists found that Democrats may have
lost control of the lower chamber (and thus the ability to, say,
tweak the law during key implementation years) as a result of
voting for the health law.
It’s true that there’s not perfect precedent for the total
repeal of a law as sweeping as Obamacare. But major health reforms
have been wiped from the books before. The Medicare Catastrophic
Coverage Act, for example, was passed in 1988. A year and a half
later, the law, commonly known as Cat Care, was repealed after
extremely
angry senior citizens refused to pay a tax financing an
expansion of the health program’s catastrophic coverage.
As a 1990 post-mortem of the law in Health Affairs
said,
“a retrenchment of this magnitude is unprecedented in postwar
social welfare policy.” It had never happened before, which meant
that no one really thought it was possible. But it did happen. The
public pressure was just too strong.
Do I think full repeal is a realistic threat to Obamacare?
It does seem somewhat unlikely, especially since polls
suggest that support for full repeal is smaller than support for
changing the law. In any case, it would be somewhat unprecedented.
But as the Cat Care incident shows, unlikely and unprecedented
events do happen.
And full repeal is not the only plausible way that a lack of
public support could affect Obamacare. A law does not have to be
repealed to be changed, and some sort of revamp, whether through a
series of smaller tweaks or in the context of a larger rethinking
and reworking of the nation’s entitlements, does seem quite
possible.
Republicans have repeatedly stated their commitment to repealing
or radically revamping Obamacare somehow. What they’ll actually do
if given power to make changes is less clear, but it seems unlikely
that they will simply leave it as is. And since the launch of the
exchanges last fall, we’ve
even
seen
several
Democrats, ostensibly the foundation of the law’s political
support, distancing themselves from the law and instead talking
largely about “fixing” it. The party’s own voters
don’t appear to be particularly motivated by the health
law.
If a law of this scale is to be judged as any sort of
sustainable success, it will need to build broader political
support—something it doesn’t seem likely to gain when even
representatives of the party behind it are implicitly describing it
as broken.
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