If the Affordable Care Act is implemented and works as supporters believe, will it wind up popular after all? I don’t think so. Instead, I expect the ACA, if it works, to basically disappear.
Ezra Klein wrote a very smart piece over the weekend about the limits of the “bully pulpit” in convincing people to support presidential initiatives – in this case the Affordable Care Act. I’m going to disagree, however, with one point:
If the Affordable Care Act is ever going to become the popular piece of law that its supporters hope it is, it’s not going to be because Democrats finally figure out the magic jingle necessary to sell it. It’s going to be because it sells itself by providing insurance to 30 million Americans. But it doesn’t really start doing that until 2014. The question for the law’s supporters is how to keep it alive until then. And the answer, at least in the White House, is simple: Reelect Obama.
I don’t think this is correct. Given that opponents have personalized the legislation as “Obamacare” there’s certainly the possibility that if Barack Obama winds up very popular that anything associated with him becomes popular (and vice versa), but beyond that?
I doubt it. Remember, there’s no specific thing out there called “Affordable Care Act,” much less “Obamacare.” What’s going to be visible to most people if ACA is implemented and works will be the exchanges, but even that isn’t going to be all that visible or noticeable to people; will people even associate state exchanges that look like this with Obamacare?
A lot of the insurance reforms, meanwhile, will be almost completely invisible from the start or else rapidly become so. Sure, ending recissions is a huge deal…but almost no one was aware of recissions unless it happened to them. It’s also a major change to force insurance companies to spend a high percentage of premiums on benefits, but no one is going to know about that, either (yes, there are going to be rebate checks this summer and perhaps in the future – checks that few will attribute to ACA). The first round of people with pre-existing conditions who are able to get health insurance after previously having been denied coverage will certainly know about and appreciate the reform. After that, however, a lot of people who get insurance won’t ever know that their minor health problems would have made them uninsurable in the old days. Most of the insurance regulations will fall into one of those categories.
What else? Medicaid expansion, for better or worse, will rapidly cease to be thought of as Obamacare and will just become part of Medicaid. The various cost controls, many of them operating within Medicare? They’ll likely just become part of Medicare.
That’s certainly not to say that intense fights around all of the components of the ACA will fizzle out. They won’t. But they’ll be fights about Medicaid, Medicare, taxes, subsidies levels, and specific regulations – not, after it all gets implemented, about “Obamacare,” because the various pieces are probably not especially likely to still be thought of as Obamacare. The fights will go on, but Obamacare may just plain disappear.