A Bold Obamacare Prediction

Love may not mean never having to say you're sorry (what a dumb idea, anyway), but being a blogger means being able to make predictions and not really worrying about whether you turn out to be right or wrong. Oh sure, if you're spectacularly wrong, and wrong on television (see Kristol, Bill), people might make fun of you. But usually, nobody remembers. And if you're right, you can remind everyone of how clever you were.

In that spirit, let me offer a prediction. The implementation of the Affordable Care Act, a.k.a. Obamacare, begins with open enrollment for the state exchanges on October 1, with coverage beginning on January 1. Sarah Kliff, who knows as much about the law as pretty much any reporter, returned from a cruise to report that the regular folks she encountered, when they heard what she does for a living, all wanted to know whether Obamacare was going to work. This was true of supporters and opponents alike. Not that the people Sarah met on the Lido Deck are a representative sample of Americans or anything, but it does suggest that there are lots of folks who for whatever combination of reasons don't think the law was a good idea, but are still at least open to the idea that it could be a success. That's encouraging.

Sarah is modest and smart enough to say she doesn't know whether the law will succeed, but my prediction is ... kinda!

Bold, I know. But let's think about this. We know that there are going to be some problems. The law is extremely complex, and is interacting with existing markets, institutions, and interests that are themselves extremely complex. The White House, in part to temper expectations but in part because it's obviously true, never tires of telling people that there are going to be hiccups and problems that need to be dealt with, and we shouldn't be surprised when it happens. Republicans, on the other hand, have been telling everyone that implementation of the law will be such a nightmare that we'll all find ourselves staggering through the streets with blood pouring from our eyes as our freedom is ripped violently from our very souls. We also know that isn't going to happen.

A year from now, we're going to be reading op-eds from Democrats making the case that the ACA has been great for America. I suspect they'll have a strong argument in their favor. We'll also be reading op-eds from Republicans making the case that it has been terrible. It may be my own optimism or bias talking, but I suspect they'll have a few reasonable points to make, but on the whole their argument will be less than convincing. Nevertheless, for most Americans, the ACA will prove to be just OK.

Most will still be getting insurance through their employers, and even if the cost curve has been successfully bent, they won't see the kind of dramatic reduction in their withholding that would turn them into Obamacare superfans. There will be terrible things that won't happen to them, like getting their insurance rescinded or bumping up against lifetime limits or being denied coverage because of pre-existing conditions, but for the most part we don't notice the terrible things that don't happen. Even the people getting generous subsidies on the exchanges will still be paying something for their coverage, so they'll probably feel like they're getting a fair deal, but that's different from feeling like you got the deal of the century. The expansion of Medicaid will affect the most lives in the most meaningful way, but given the resistance of Republican states to it and the fact that those being helped are poor so they don't get much attention from the rest of the country, that will be a small part of the story most people hear.

So in sum, even if things work out as well as the administration hopes, it isn't as though hundreds of millions of Americans are going to wake up every morning and say, "Woo-hoo! Another Obamacare day!" If everything goes well, from most people's perspective it'll be just OK. And that's OK.



I guess I'm a superfan. I haven't had access to healthcare for I could afford to pay the premiums since 2004. I'm fifty-four years old and I'm betting that it's going to work much better than just okay for Californians like me. That weblink up there is a good primer for how Obamacare will work in California

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