July 18, 2013

Barack Obama is going to bat for the Affordable Care Act in a series of speeches. Today, he focused on the regulation that insurers must devote 80% of premiums to care — not to overhead or advertising. And he took a bit of a victory lap over the rebate checks that health insurance companies sent out last summer and this summer. The key point in today’s speech, however, was this:

“The good news is that starting October 1st, new online marketplaces will allow consumers to go online and compare private health care insurance plans just like you’d compare over the Internet the best deal on flat-screen TVs, or cars or any other product that is important to your lives.  And you’re going to see competition in ways that we haven’t seen before.  Insurance companies will compete for your business.  And in states that are working hard to make sure this law delivers for their people, what we’re seeing is that consumers are getting a hint of how much money they’re potentially going to save because of this law.  In states like California, Oregon, Washington, new competition, new choices, market forces are pushing costs down.”

The unstated contrast Obama drew is that in Texas and other Republican-run states, where they aren’t “working hard to make sure this law delivers for the people,” things might well be different. And that’s true; it’s one of the takeaways in a terrific article on implementation from Ezra Klein and Sarah Kliff (highlights here).

Republican resistance to “making sure this law delivers for people” probably won’t matter, in the long run. In the short run, yes — lots of people are going to go without insurance because of GOP dead-end opposition, and generally there will be more of what the president calls “glitches” in states where the government is rooting for failure instead of working for success.

But in the long run? No big company is going to dump their company-provided health insurance and toss employees onto the exchanges because management hates Obamacare and wants to undermine it. Very, very, few uninsured people are going to refuse to buy private health insurance through the (government-run) exchanges because they want to bring down the Kenyan socialist in the White House. And eventually, whether it takes months or years or, even, a decade, the states will come around to implementing the law.

That’s assuming that the basic structure of the exchanges and subsidies works; it’s also assuming that businesses don’t suddenly pull the plug on insurance not because they hate Obamacare, but if the incentives in the law turn out to be structured poorly.

Regardless of how muddled the roll-out is, however, the basic formula here (which, don’t forget, means people getting very real benefits that they’re not going to want to give up) means that the Affordable Care Act is here to stay. The battle over universal coverage is basically won, even if the mopping-up operations go on for quite some time. Sure, there are going to be plenty of future battles over health care. However, we’re not going back to 2008.

In his speech, the president also took note of “a lot of folks — in this town, at least — who are rooting for this law to fail.  Some of them seem to think this law is about me. It’s not.”

Not only is that true, but it’s going to be even more true going forward. Barack Obama isn’t going to be on a ballot again. At some point, perhaps as soon as a year from now, he’s going to start fading as a Republican target.

And yet the Affordable Care Act — the exchanges, the subsidies, the regulation, not to mention all the cost-savings experiments and, yes, the taxes — will still be around. Just remember: the better all of it works, the more invisible it’s going to be.

It’s not about Barack Obama; it’s not about Democrats and Republicans, even. It’s about getting health insurance to work. If that happens, everyone — even those who will probably still hate Obama — are going to be perfectly happy with it.