Obamacare will never be a huge political success for Democrats

July 18, 2013

Over at Slate, Matthew Yglesias lays down a marker: "Obamacare implementation is going to be a huge political success," he writes.

Paul Krugman agrees. He calls Obamacare "the right's worst nightmare."

(Photo by Jessica Rinaldi/Reuters)
(Jessica Rinaldi/Reuters)

I don't buy it. If I were betting, I'd say stories about various problems in the implementation of Obamacare will be a net negative for Democrats in 2014, and after that, the program will cease to matter much politically at all — even as it works pretty well, and the coverage it offers is pretty popular.

The key thing to remember about how people will experience Obamacare is that most people won't experience it at all, and those who do experience it will never, ever experience a program named "Obamacare."

If the law works, then a decade from now, about 25 million people will be insured through Obamacare. About half of them will be insured through Medicaid. The other half will be insured through state insurance marketplaces with names like "Covered California" and "Health Access CT." They'll get this insurance because their minister will mention it to them or because their community health clinic will sign them up. Few of these people are likely to connect their coverage to that Obamacare thing they heard about a lot back in 2010.

Conversely, there are parts of Obamacare that are likely to forever be associated with Obamacare: The individual mandate, for instance, or the tax on particularly expensive, employer-provided health insurance plans. Whenever people run into these parts of the law, they will associate them with Obamacare, though I doubt the political effect from these provisions will rise beyond "marginal."

Insofar as the coverage Obamacare offers is popular, and it probably will be, the core program will become untouchable. We'll go from "repeal-and-replace" — though Republicans never did come up with the "replace" part — to "tweak-and-improve". But I doubt it'll ever move the needle much for Democrats. By the time a frontal repeal assault would be bad national politics for Republicans, they'll probably have abandoned it. Indeed, they may execute a full flip and begin arguing to bring Medicare into the Obamacare exchanges as a more politically palatable way of achieving premium support.

The caveat to this is that in a number of states, Republican governors and legislatures are taking steps to sabotage their health-care system in order to strike a glancing blow against Obamacare. In Texas, for instance, Gov. Rick Perry is refusing the Medicaid expansion — which means he's denying a huge number of his constituents health coverage, and he's denying the state a lot of money, and he's putting his hospital systems under enormous financial pressure.

It's possible that this kind of self-sabotage could backfire on the politicians carrying it out, and in that way, Obamacare could move the political needle in states like Texas and Georgia and Louisiana. But I wouldn't even bet on that.

That said, what Obamacare will do if it succeeds is move the policy needle in a very big way. It will cement the government's commitment to ensuring pretty much every legal resident has quality health insurance that they can afford. That will become an uncontroversial statement on the left and the right in the United States, just as it is on the left and the right in Europe. That's a huge deal, even if it doesn't swing any elections toward  the program's authors.

Related: Inside the White House's plan to sell Obamacare

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