Obamacare – Who’s Winning and Who’s Losing?

President Obama tried to shoot the moon. Did he miss?

President Obama tried to shoot the moon. Did he miss?

For the next few hundred words, let’s set aside all the substantive questions about the Affordable Care Act (ACA), also known affectionately (and otherwise) as Obamacare. Is it good or bad policy? Is it a socialist takeover of medicine, or is it a warmed-over Republican plan from the ’90s? Does the individual mandate mean that one day you’ll be forced to – banish the thought! – eat your broccoli? Instead, let’s take a look at who the political winners and losers are.

First, the clear winners: Republican candidates for local and statewide office. After the 2008 election, the national literati were falling over themselves to relegate the GOP to the dustbin of history. The meme of the day was the idea of a permanent Democratic majority – Bush and the financial collapse had broken the back of the Republican party, and Obama had finally put together tomorrow’s permanent coalition.

How did that work out? The truth is that the political analysis after every election is hyperbolic, so it’s no shock that the early reports of the GOP’s demise were greatly exaggerated. Even so, it’s somewhat arresting to consider just how little Republicans have managed to move beyond the problems that led to electoral defeat in 2008. They still have no idea how to talk to women, minorities, or poor people. They haven’t figured out how to move forward on immigration reform. They failed to regain the White House in 2012 and have lost the popular vote in three out of the four national elections since 2006.

In fact, just about the only issue where Republicans have managed to break through  on, outside of the conservative media establishment, has been on the ACA. For all the rifts in the party, Republicans have demonstrated vintage-quality discipline on healthcare. Putting the substantive policy loss aside for the moment, Obamacare was a big win for Republican candidates.

That’s about it, though. Everywhere else you look, it’s hard to see anything but political losers. In fact, if you move back a step and look, not at the state level and local candidates, but instead at the national party, it’s pretty clear that Obamacare hasn’t been great for the GOP. It’s hard to say how big of an effect Mitt Romney’s baffling opposition to the national version of the same plan he championed in Massachusetts had on his presidential campaign, but it doesn’t seem to have helped. In addition, we shouldn’t be too quick to gloss over the fact that the Republican Party has used every political tool at its disposal to repeal Obamacare – and they’ve failed. As a rule, political parties don’t benefit from losing fights that they go out of their way to pick.

What about the other end of the spectrum – has Obamacare been good for progressives? Hardly. With all the talk of socialized medicine, it’s easy to forget that the first thing that Candidate Obama did when he entered the discussion over healthcare was to take the left’s preferred policy – a single-payer system – off the table. The next thing he did, after he had cut a deal with healthcare providers, was to take the left’s second-favorite idea – a public option – out back and unceremoniously bury it. Progressives were left holding a plan that looked an awful lot like what the conservative Heritage Foundation had proposed as an alternative to Hillary Clinton’s efforts during her husband’s administration.

In addition, Obama has proved to be a pretty dismal standard-bearer for progressives. This far into his tenure, I feel confident in concluding that the President seems generally unable to meaningfully convince people who disagree with him of the merit of his positions. Now, it looks like he’s also lost the ability to engage and energize those who agreed with him to begin with. After winning reelection in 2012, the White House laid out plans for turning Obama for America, the President’s electoral juggernaut, into Organizing for Action, a group that would help coordinate support around his legislative agenda. Queue the sound of crickets chirping.

It’s hard not to conclude that the biggest political loser from Obamacare isn’t Barack Obama. The President came into office making no secret of his wish to be a transformative president, and healthcare reform was the linchpin of that effort. Whether or not the bill proves to be successful at reforming the healthcare market, it’s obvious that the larger political goal has been lost.

Why? In short, because the President secured passage of a comprehensive bill without the ability to pursue the inevitable fixes that would be required. When Massachusetts passed a similar law, the plan ran into unforeseen speed bumps. As a result, the legislation passed technical fixes to the plan a number of times. That’s what happens when you do something this big, which is why sweeping reforms require high levels of political consensus. But Obama failed to plan for how to deal with that challenge.

The critical moment came when, ironically enough, the long-serving Senator from Massachusetts, Ted Kennedy, died in 2009 from a brain tumor. In a surprise, Bay Staters sent Republican Scott Brown to fill his seat and the Democrats lost their filibuster-proof Senate majority. The White House had a choice: either go with an earlier, but unfinished, version of the bill that had previously made it out of the Senate, or go back to that body and try to find a single Republican vote. The choice they made – to go with the earlier bill and pass a law they couldn’t have gotten through the new Senate – was predicated on the fear that otherwise they would get nothing.


Was it the right thing to do? I can’t answer that, but I can say that it put the President in a bind. He had just passed a bill he knew he couldn’t amend. His challenge over the next electoral cycle would be to ride out the surging wave of Republican opposition and carve out the political space needed to revisit the ACA. Instead, he lost his majority in the House and even more votes in the Senate. Since then, the White House has been in retrenchment mode on the ACA – throwing more and more political capital into a Rube-Goldberg-machine-styled law that the Republicans won’t allow them to revisit.

In 2012, the Supreme Court struck down Obamacare’s Medicaid expansion, putting further distance between the law the White House wanted and the law they’re now forced to defend.

The first rule of politics is to win. The second rule is to win victories worth having. Time will tell whether or not passing healthcare reform was worth it or not – but the political landscape for President Obama isn’t looking good. Democrats like to roll out the fact that, despite disliking the law, Americans support most of what’s in it. They see that as vindication of their policy win. But accepting that as solace is also a self-defeating acceptance of their political loss.

If Mr. Obama can’t turn his presidency around, it will prove to be little comfort.

Follow Pedro on Twitter @IamPedroA.

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