Why the CBO matters, health reform edition

Paul Starr makes a smart point in his recent Washington Post op-ed on the health reform law. The law’s unpopularity, he argues, has a lot to do with the fact that it had to be constrained to get a good score from the Congressional Budget Office:

Primarily to ensure that the Congressional Budget Office would “score” the legislation as reducing the deficit, Obama agreed to delay implementation of the major provisions of the law until January 2014, nearly four years after the bill passed. And contrary to his position during the 2008 campaign, the president also agreed to an individual mandate — again, partly to keep down the program’s cost — even though the mandate predictably became the law’s most unpopular provision and the focus of legal and political challenges.

These concessions have had opposite effects on the emotional commitments in the two parties. While opposition to the mandate has become a rallying point for Republicans, the long delay in implementing reforms has left many Democrats discouraged and uncertain about the law’s benefits. The four-year timetable also undercuts any possible political gain from the reforms; the president will have little to show by the 2012 election and little chance of clearing up the confusion and anxieties about the law.

The four-year implementation timetable also leaves the Affordable Care Act more vulnerable if Obama is not reelected. Any Republican coming into office would face procedural hurdles to repealing health reform. But, politically, it would be less of a challenge to stop new programs from launching as opposed to the more fraught task of taking away benefits already rolled out.