*That is, if a small fraction of the American population needed to apply for driver’s licenses, with most people getting permission to operate a car from their employer instead.
The Affordable Care Act is just about at the point where repeal is impossible. The Supreme Court has another chance to try kicking it over, thanks to a lawsuit arguing that the law as written does not allow people who get private health insurance policies through the federal exchange (healthcare.gov) to get any federal subsidies to help pay for these policies. (Alec MacGillis explains the case here.)
This court challenge demonstrates the say-anything strategy of hard-core Obamacare foes, since it contradicts the argument, now being made by House Speaker John Boehner, that the ACA is a terrible thing because so many people will have to pay more in premiums. Compared with the Republicans, the libertarian view is more logical, if not so nice for someone like Tiny Tim. Reason magazine likes to remind us that we live in “a universe with scare resources,” and the implicit point of its Obamacare coverage is that it’s insane to even attempt delivering basic health care to all Americans.
But barring a Supreme Court curveball, “Repeal Obamacare?” will cease to be a serious question as new political dramas unfold in 2014. There may still be problems — there may still be a lot of problems — with people who don’t get insurance through their jobs having to grope their way toward plans that meet ACA requirements. But the structure through which under- or uninsured people can get health insurance policies (regardless of any pre-existing conditions) is not going to be torn down. Not in an economy where so many people can easily imagine losing their jobs.
Mother Jones’ David Corn writes that the Republican Party could suffer mightily if the ACA is a success: "If the website functions, millions sign up, and the health care market doesn’t crash, and premiums don’t zoom up — and this will be on top of the already existing benefits of Obamacare, including removing preexisting conditions restraints, allowing young adults to remain on their parents’ policies, reducing out-of-pocket prescription drug costs for seniors, and forcing insurance companies to devote a higher percentage of premiums to health care coverage — where will the Republicans be? Not only will they be failed doomsayers; they will have lost the No. 1 item on their why-you-should-vote-GOP list. Their anti-government crusade will be derailed. They will be a train without a motor."
That scenario seems far too rosy for the Democrats. The American anti-government crusade may slide backward at times, but it will never be derailed.
It is an article of faith among Republican-leaning voters (let’s say 47 percent of the electorate) that anything government does is inefficient and wasteful. Some Obamacare opponents have disparaged the new health-insurance bureaucracy by comparing it to a Department of Motor Vehicles — which many people find exasperating to deal with, though DMVs are run by states, not by the supposedly more lumbering federal government. (You can buy a bumper sticker that reads “Obamacare: Bringing the DMV service you love to the life and death needs of your health.)
Someone at the Forbes website slapped the headline “The Obamacare Exchanges: Nowhere Near As Competent As The Post Office” atop a column on the “abject failures” of the websites associated with the ACA, and I think the headline writer was being sarcastic, despite the U.S. Postal Service being one of the most efficient government services in the world. (The guest columnist didn’t mention the mail at all.) Meanwhile, the Wall Street Journal’s Peggy Noonan mocked Barack Obama for even proposing something so complex when “the government can barely put up road signs.” Is there really a consensus that government can’t match the private sector in the erecting of signs? Well, yes if you believe that government is inherently wasteful and no if you believe that it’s no more wasteful than any other large-scale institution. No voter is going to change his or her mind based on a study on how just efficiently the highway department bangs poles into the ground.
I’m more inclined toward the view of the Washington Post’s Jonathan Bernstein, which is that health care is returning to its status as a “normal issue” in American politics, with constant debate over specifics (as there is over Social Security and Food Stamps, and the federal role in education) rather than over the very existence of the ACA:
Expect, for example, Republicans to eventually fight over subsidy levels (and, perhaps, both parties to try to refashion subsidies to avoid perverse incentives on earnings). Expect, too, Republicans to eventually try to reduce ACA-connected taxes. There’s been some of that, but so far it’s mostly been restricted to things that could be outright repealed. Expect, too, plenty of oversight by this and future Congresses over all phases of it. After all, there’s more to oversee now.
The point is that even as the debate about “Obamacare” eventually fades away, we shouldn’t expect health care to vanish as an issue. Indeed: expect it to be more central to U.S. politics going forward.
Health care will still be an issue next year, but the 2014 midterm elections will not be a referendum on Obamacare. For almost all voters, the new health care law will be folded into their pre-existing views toward government. ACA, DMV, FBI, IRS… how many voters make distinctions among them?
Photo from Simpsons.wikia.com of the Springfield Department of Motor Vehicles. Ask for Patty or Selma Bouvier.