At his presser today, President Obama was asked to respond to the fact that even some Democrats are worrying that implementation of Obamacare could create major problems. In response, Obama conceded that setting up the exchanges is a complicated task, and he acknowledged that GOP efforts to stymie the law on the state level were making implementation difficult.
But Obama also argued that implementation would likely only impact a small portion of the population, and concluded:
“The last point I’ll make, even if we do everything perfectly, there’ll still be, you know, glitches and bumps, and there’ll be stories that can be written that says, oh, look, this thing’s, you know, not working the way it’s supposed to, and this happened and that happened. And that’s pretty much true of every government program that’s ever been set up.
“But if we stay with it and we understand what our long-term objective is, which is making sure that in a country as wealthy as ours, nobody should go bankrupt if they get sick and that we would rather have people getting regular checkups than going to the emergency room because they don’t have health care — if — if we keep that in mind, then we’re going to be able to drive down costs, we’re going to be able to improve efficiencies in the system, we’re going to be able to see people benefit form better health care, and that will save the country money as a whole over the long term.”
A few points about this. First, when Congressional Democrats openly worry about implementation, that’s not necessarily a bad thing: That’s what they are supposed to be doing, i.e, calling for the policy to be executed successfully. There are certainly more constructive or less constructive ways for Dems to do this — Max Baucus’s “train wreck” comment is decidedly in the latter category — but calling for attention to be paid to implementation does not necessarily constitute running away from the law politically. Indeed, Democrats and Democratic candidates can — and should — criticize implementation where it’s falling short, while not tarring the law or its goals as a whole. That shouldn’t be too difficult a balance to strike. Indeed, if they do strike that balance, it could go some way towards insulating them from political blowback over implementation’s problems.
Republicans are very confident that pending implementation difficulties will give them a major issue in 2014 in a way it didn’t in the last cycle. There’s no denying that there will be problems. But as Jonathan Cohn has explained at length, whatever problems we do encounter will be far, far preferable to the pre-reform status quo and even to the present. This isn’t to say that if implementation does go badly that it won’t be somewhat politically problematic. It may well be; a lot will turn on who is impacted and how. But Obamacare — as a whole, at least — has polled badly from the outset, even in years such as 2012 where Democrats won across the board, despite truly enormous GOP expenditures on ads attacking Democratic candidates over the law. Given that context, it’s hard to see how implementation challenges could produce that big an additional swing against Obamacare, let alone one that would be decisive in multiple Congressional elections.
Finally, can Republicans really reap huge political dividends from implementation failures if they continue to call for full repeal of the law — which continues to be the de facto party-wide position, one demanded by the base — while failing to offer any meaningful alternative to replace it?
Republicans are excitedly pointing to a new Kaiser poll finding that only 35 percent approve of Obamacare. That’s bad — but only marginally more (40 percent) disapprove, and again, how much more of a swing against the law can still take place next year? Indeed, the Kaiser poll also finds that nearly a quarter remain undecided on the law. And 58 percent disapprove of cutting off funding for it, while only 31 percent approve of doing that. This mirrors many other polls finding only around one third of Americans favor full repeal; large chunks of the electorate who disapprove of the law simply want it changed. As unpopular as Obamacare may be — and whatever problems implementation brings — large majorities apparently don’t want to return to the free-for-all that reigned pre-reform; they want the health care system fixed.
I’m skeptical that Republicans can capitalize in a big way on implementation of Obamacare without offering a meaningful alternative to replace it, particularly if Democrats handle this smartly and critique implementation without running away from the law as a whole. And that’s what I think Obama was getting at with his remarks today. He was lowering expectations for implementation by acknowledging that it will be hard, while simultaneously reminding Democrats that the law’s larger goals remain worth fighting for, and are far better than the alternative.