Obamacare: The Fight Is Hardly Over

The healthcare law has found new momentum—but it hasn't assured its permanence.

Obamacare’s brief existence has been fraught with near-death experiences. At various points, it seemed unlikely to pass despite three-fifths Democratic majorities in both houses of Congress. The coalition behind the Affordable Care Act, stretching from pro-life Democrats to liberals who preferred single payer, appeared to be unraveling.

Once enacted, Obamacare had to survive a constitutional challenge. Solicitor General Donald Verrilli had a bad day defending the law in court, inviting unflattering comparisons to the bumbling, stumbling lawyer in My Cousin Vinny. (Googling to double-check the spelling of Verrilli’s name, the search engine prompts me to look for “Donald Verrilli incompetent.”)

Even the liberal Supreme Court justices seemed skeptical of the Obama administration’s legal reasoning. Court watchers began to suspect the law would be struck down. If all the conservative Republican appointees had stuck together, it would have been struck down.

After the controversial health care law survived both the Supreme Court and the 2012 presidential election, it looked like it might be killed by its own implementation. The year began with more private health insurance plans cancelled due to Obamacare than enrollees in the insurance exchanges. Abysmal enrollment figures, a premium “death spiral” and even a net reduction in the insured all seemed possible just a few weeks ago.

With the Obama administration now announcing 7.1 million people have signed up for the exchanges, the direst scenarios have been averted (at least for now). The law still isn’t working exactly as advertised, and those enrollment figures may well wilt under serious outside scrutiny, but it is working well enough to survive.

Yet the law’s supporters—especially the president—should temper their enthusiasm. “The debate over repealing this law is over,” President Obama enthused in the Rose Garden. “The Affordable Care Act is here to stay!”

Much like predictions of the law’s demise, there have also been repeated assertions that the Obamacare debate is over—and they have turned out to be equally wrong. Aside from one ABC News/Washington Post poll that is clearly an outlier, public support for the law hasn’t budged. The public opposes it by double-digit margins.

No matter how much chicanery is ultimately found to be behind the numbers, the Obama administration deserves some credit for getting to 7 million if for no other reason than they would be getting the blame if they hadn’t. And obviously, some people are helped by the law.

But unofficial estimates suggest at least two-thirds of the people with private insurance from the exchanges were previously insured. (The federal government hasn’t released official data on this). A second of many waves of insurance cancellations is coming, culminating in a final number—93 million, the administration estimated in 2010—that dwarfs the 7 million.

Even Health and Human Services Secretary Kathleen Sebelius acknowledges premiums will rise next year—the administration says by a little, insurers say by a lot. McClatchy reports new research estimates that about half of those with subsidized coverage obtained from federal or state marketplaces will lose it within a yearbecause of changes in their incomes or other family circumstances, such as divorce, relocation or the births of children.”

And these are the people currently benefitting from Obamacare. Many other Americans facing problems of cost, access and dropped coverage are the law’s victims. Senate Majority Leader Harry Reid may deny they exist, but that won’t stop them from voting out Democratic senators in November.

The Obamacare impasse remains. Just because the Democrats couldn’t pull U.S. troops out of Iraq didn’t validate George W. Bush’s assurances staying the course would work well.

Obamacare supporters do have one important thing going for them: the longer a government program survives the more constituencies it creates and the more it benefits from inertia even if it doesn’t work very well. That is why Democrats keep waiting out each of the law’s problems and the president keeps insisting Obamacare is a settled issue (unlike, say, the Bush tax cuts).