Obamacare as written is already gone, dismantled by its namesake. Obamacare itself has not, strictly speaking, collapsed of its own weight. Rather, it has been changed from its original, unworkable form first by Chief Justice John Roberts and then by the president into some new, unworkable mishmash. Obamacare per se is already gone. The question remains whether the law in some form will remain or whether the 2016 contest will be about what sort of plan replaces Obamacare. The latter is the odds-on favorite.
David Brooks on “Meet the Press” yesterday predicted (correctly, in my view) further undoing of the law in 2014: “The American people don’t like mandates anymore. We’re a much more individualistic culture. And every moment when the administration has been faced with either mandating something or surrendering on this bill, they’ve surrendered each time. They’ve weakened each individual mandate all the way along. So you have to expect they’ll weaken and surrender on the mandate down the line.” That is in effect leaving only the shell of Obamacare still in place, a kind of face-saver for the lame-duck president.
The case for repeal of Obamacare builds each day. CNN reports support for the law has evaporated. Only 35 percent support it while 62 percent do not. Democratic support is way down as well (to 59 percent). Nearly 20 percent think it is not liberal enough, whereas 43 percent think it is too liberal.
As a pragmatic matter, the Democratic nominee will at the very least need to run on some serious modifications of Obamacare and very likely on a single-payer plan. The Republican, any Republican, nominee will run on “repeal entirely and replace.” Why in 2016 would anyone run on the new status quo, a problem-ridden and hugely unlikable scheme? Once the race to replace President Obama is underway and certainly when he is gone, the incentive to preserve Obamacare evaporates. Now the only thing holding back the tide on the left to sweep the health-care wreckage out to sea is the understanding that it will definitely doom the remainder of the Obama presidency.
The good news for Republicans is that the president has really done a lot of the heavy lifting in pushing Obamacare to the side. On his Facebook page, Sen. Jeff Flake (R-Ariz.) writes, “The original Obamacare construct was that while insurance companies would be forced to offer extensive coverage and enroll individuals with pre-existing conditions (thus substantially driving up the cost of coverage), the individual mandate would force so many previously uninsured individuals to buy the coverage that it would all pencil out in the end. But now the coverage and guaranteed issue requirements for insurance companies on the exchange remain and the individual mandate requirements are being gutted. It just doesn’t pencil out anymore – if it ever did.” Precisely so. Moreover, the remainder is now a very expensive and otherwise disruptive plan for very few people. Flake recognizes that Obamacare-the-sequel is nothing more that “a nationwide high-risk pool for the middle class. This surely isn’t the most efficient way to insure the otherwise uninsurable, but such marginalization of Obamacare would be vastly better (and infinitely cheaper) than forcing everyone else, specifically the otherwise insurable, to buy coverage they don’t need
and/or cannot afford.”
We therefore end 2013 with Obamacare disappearing piece by piece. The people still desirous of getting insurance through the exchange will be a discrete and small enough group to address in ways that leave the rest of us and the economy unburdened. (For the billions we are spending on a million, at most, people in the exchanges, we could give them their own doctors and unlimited taxi rides to free appointments.) That should be the goal in 2014 for Republicans, namely to deal with the middle class hard- to-insure while working on the “affordable” part of the equation for others who have or had insurance (before Obamacare took it away). That is a much easier task than it was at the start of 2013. For that, we have Obama to thank.