October 1, 2013

Today is the day the health care exchanges open at healthcare.gov. Initial reports of what it’s like are coming in; Wonkblog is all over it, with reports of bad experiences and somewhat better ones. Apparently, the computer interfaces are having some troubles, and that they’re having some difficultly with higher-than-anticipated traffic levels. And with all of that comes the next round of spin.

Don’t worry, though: The fate of Obamacare isn’t going to be determined by public relations.

We’ve been subjected to over three years of spin warring ever since the Affordable Care Act passed in March 2010.  With the exchanges opening for business, it’s getting more intense. See for example this debate last week over whether full time jobs have been jeopardized, or this one about glitches in the roll-out. We’re going to hear plenty more — expect Republicans to blame absolutely everything that goes wrong with any medical case on Obamacare, and expect Democrats to trot out their own stories of people whose financial future, and maybe their lives, were saved by the ACA. Republicans, in particular, seem to have convinced themselves that the program has already failed and that Democratic politicians are bailing on it all, despite all evidence that Democrats remain remarkably unified — as they’ve showed in the government shutdown fight.

Forget about all of that. For the basic future of the program, only one thing really matters: does the product work, or not? Not whether Rush Limbaugh says it’s working. Not who hustles out the best stories about broken web pages (or smoothly running encounters). The facts of the situation really are going to dictate what happens.

If the exchanges implode, the ACA will fail and be repealed. That is, if healthy people on the individual market choose to go without health insurance, it will mean the math won’t work, and the program will be a disaster. But people aren’t going to decide whether to get health insurance based on their politics. If there’s a good product, relatively easy to buy, at a good enough price, then they’re going to purchase it. If not, they won’t, and the political support for Obamacare will disappear relatively quickly.

However, if people do sign up — if the program works at a basic level — then it will be game over.

There’s just no way that anyone is going to take away health insurance from millions of mostly middle-class people. It jst isn’t going to happen.

Republicans may continue, by the way, to campaign against “Obamacare,” and it’s certain that they’ll have Obamacare horror stories (true or not) that will continue to play well with Fox News audiences. After all, a large percentage of those people buying insurance through the exchanges may never realize that they’re “on” Obamacare, since neither that word nor “Affordable Care Act” will show up in any of the material they see, even as they are partaking of its benefits. And of course there are still going to be plenty of real debates about funding levels, specific regulations, and other post-Obamacare health issues.

There’s no way, however, that Republicans would actually shut down the exchanges, repeal the subsidies entirely, and restore the status quo ante. Just as Republicans, for all their rhetoric, didn’t shut down Social Security or Medicare when they had unified government in the last decade.

Spin might well affect whether Obamacare polls well or badly. It might even affect the electoral consequences, if any, of the program. But the survival of the ACA itself at this point is pretty much entirely dependent on the stubborn facts of whether it actually runs more or less the way its designers anticipated. If it does, Obamacare isn’t going anywhere.