It suggests that the administration is giving up on the long game of doing what it takes to get the system into place and then trusting that the public will come around and is adopting instead the mentality of a political war of attrition, fought news cycle by news cycle, in which the goal is to survive and gain some momentary advantage rather than to achieve a large and well-defined objective. It suggests, in other words, that the administration is coming to the view that Obamacare as they have envisioned it is not really going to happen, that they don’t know quite what is going to happen (and no one else does either), and that they need above all to keep their coalition together and keep the public from abandoning them so they can regroup when the dust clears.
In trying to save himself from political humiliation, the president is willing to bleed the exchanges of bodies (healthy and young ones, at that) essential to his legislative scheme. In conceding things really aren’t going to be working perfectly by Nov. 30, he’s gone a long way toward discouraging more people from bothering to check it out. (Coupled with uncertainty about the Web site’s security, there is a considerable disincentive to spend any time on the ordeal.)
We therefore face the real prospect that a few hundred thousand people, not a few million, may have signed up through the exchanges by the end of the year. Even worse, these are likely to be the sicker and older people. The administration would then have four choices.
It could, I guess, proceed as if nothing is wrong. Of course, the prospect of fining millions of people would be unseemly and onerous. The question then would loom as to why we’ve disrupted the entire country to cover a few hundred thousand hard-to-insure people.
That would lead to a second option: Delay of the individual mandate. The irony would be delicious, but the president might have no other realistic choice while the Web site is getting fixed and the exchanges are sorting themselves out. In the meantime, the exchanges begin to look like a high-risk pool, but one for which the insurance companies didn’t plan. Lifting the individual mandate, of course, would make it even harder to attract bodies to the exchange. (This in essence is a bigger version of the president’s current stunt in letting individuals stay in their 2013 individually purchased plans.)
A third option would be Rep. Fred Upton’s (R-Mich.) legislation, namely that the president allows anyone to buy the plans available for individuals in 2013. That is one more step toward giving people an excuse not to sign up through the exchanges. (At this point the insurance companies are in full revolt, having planned for none of this.) This may lead for demands from employers to allow their employees the same luxury (i.e. get a catastrophic, low-cost plan).
A fourth option would be to raise the white flag: Sit down with Congress to figure out what can be saved and what cannot be.
Levin cautions, “It may turn out, of course, that the situation of Obamacare and its champions is not in fact this dire, that the exchange system will find some balance relatively soon and function in a way that bears some resemblance to how it was designed to work, and that the politics of health care in 2014 will be more mixed and complicated than the fiasco the Democrats now face.” If so, the White House will come to see this past week as a political overreaction.
What would it take to get Obamacare semi-operational? The Web site would have to be working very well, so well that the frustration factor is eliminated entirely. The insurance companies would have had to figure out how to keep the canceled insurance policy holders on their 2013 policies to as to quell the cancellation uprising. Millions of people would need to get past sticker shock and decide to purchase insurance (not just put it in their “cart,” as some portion of the 106,000 have done). And the back-end systems would have to work well so their data gets to insurers properly and without any security lapses (which would cause further panic). But how likely is all that? I think we can agree it is at the very best a 50-50 shot.
Now soak that in for a moment. It is a coin flip, at best, for the president as to whether his signature achievement, his only achievement, will fail. It will be repealed in essence by a popular referendum: The mass refusal of people to go along with Obama’s top-down, compulsory system that was set to transform a sixth of the economy. That possibility should traumatize and probably is traumatizing the White House. Same goes for any Democratic lawmaker who spent time thinking this through. The political implications of this are almost too enormous to calculate.
The greatest chance to get rid of Obamacare without Republicans keeping the House and winning a filibuster-proof Senate majority and the White House is to highlight just how bad Obamacare actually is and to offer more and more off-ramps for people to stay outside the exchanges. Upton did more than the shutdown squad ever accomplished in getting 39 Democrats to turn on the president. Republicans and red-state Democrats can press the Senate to do the same and pound Harry Reid and his troops if they don’t at least allow a vote. Republicans, in other words, must be patient and persistent while moving ahead with an alternative of their own that could attract Democratic support.
As for Democrats, maybe they should start thinking about an Obamacare alternative. There is a good chance they will need one.