Conservative health-care reform critic Philip Klein has a nice article with a reasonable list of five ways that the Affordable Care Act (ACA) could break down. For example, if enough “young healthies” don’t sign up and accept the (modest) penalty, there’s a real chance of a death spiral in which only people who need lots of benefits, people who previously might not have been able to get coverage because of pre-existing conditions, sign up. That’s a real danger.
I think the best response, however, is from Rich Yeselson, who notes:
Yet every issue here could be remedied by GOP government officials–administrators and pols–of good faith.
For example, Klein writes:
Worse yet, the public remains ignorant about the exchanges. A June survey from the Kaiser Family Foundation found that a combined 79 percent of the public had heard either “only a little” or “nothing at all” about the exchanges. If a planned media blitz fails, the exchanges may not attract enough enrollees. Under such a scenario, those most likely to educate themselves about the exchanges and go through a confusing process of applying for insurance would be the sickest and thus most expensive to insure, which would make the exchanges unsustainable.
Well, yes. So what has Klein been up to all day, the same day that this analysis is published? Joining Republican leaders in what appears to be a successful effort to scare off the NFL from participating in that “planned media blitz.”
Similarly, Klein reports that Health and Human Services could have trouble getting the exchanges up and running, including an easy-to-use computer interface, on time. What he neglects to mention is the not-stop, and partially successful, effort by Republicans in Congress to prevent the executive branch from having funding to get it right. That’s why any honest list of ways the legislation could fail is going to be dominated by things that are really “how Republicans could undermine it” rather than “how it might not work.”
That’s certainly not to say that the ACA has no flaws or weaknesses; no one thinks that. But normally, once a bill passes, the government tries to implement it the best it can, and Congress tends to help by passing fixes as needed, funding implementation at reasonable levels, and (not least) by using rigorous oversight to make constructive criticisms with the intention of making sure executive branch agencies get it right.
It’s possible that the ACA will collapse. But if it does, it’s unlikely it will be the result of inherent problems with the legislation. If Obamacare fails, it’s going to be because the Republican Party’s all-out war on it — a war that doesn’t seem to have any concern at all for health-care consumers or the economy — succeeds. Whether that’s a good thing for health care? Well, that doesn’t seem to be part of the equation.