When the story of Obamacare is written many years hence, the historians and political scientists of the future will have an embarrassment of riches to dig through. (Remember the ‘Cornhusker Kickback’?) In tomorrow’s history of today, it isn’t too difficult to imagine a particularly earnest graduate student devoting chapters to explaining the law’s ebb and flow through the prism of how it came to be derided as ‘Obamacare’, only to have that name embraced by the President. In the wake of the law’s embarrassing rollout, the White House seems to be once again favoring ‘the Affordable Care Act’ as the term-de-jour. Somewhere in that back-and-forth, there’s a detailed but maybe not-so-insightful paper waiting to be written.
In truth, despite setting the news cycle, I find it hard to believe that the entire rollout period will be very interesting after it’s over. Simply put, if Obama care can work, then this rollout isn’t going to kill it. Already, the law is becoming deceptively entrenched. Soon it will be like most large-scale social welfare programs: nearly impossible to kill, and difficult to reform. Frankly, the GOP might have missed their opportunity to strike while the iron was hot: instead they let the whole project solidify while they chased an electoral advantage.
On the other hand, if the law is fundamentally flawed and cannot work – as the GOP’s rhetoric contends – then the best executed rollout wouldn’t have saved it. Maybe we can all take some solace from the idea that, after all the electoral fighting is over and done with, reality gets the decisive vote.
No, for my money the most interesting thing in American politics isn’t the beltway fight that’s been receiving most of the attention; rather it’s the less visible fight going on in the states. Specifically, the move by opponents of Obamacare to try to convince young people not to sign up for health insurance under the plan’s provisions.
At the most basic level, this makes perfect sense. Putting aside the GOP’s general disapproval of the ACA, the President’s plan depends on enrolling the right balance of low-risk young people and higher-risk individuals: too few of the ‘young invincibles’ in the risk pool to balance out higher-risk patients and premiums would quickly become prohibitively expensive, scaring away all but the neediest patients, which would in turn push health premiums even higher. This is what’s referred to as the ‘death spiral’ and it’s also what led to the basic compromise at the heart of the bill: insurance companies would agree to take on all patients (regardless of risk) in exchange for a government mandate that everyone would purchase health insurance to help spread out the cost.
The problem, as it were, is that the tax penalty for failing to comply with the ACA’s individual mandate to purchase insurance was set too low. That was by design: the hope was that the mandate would send a signal for young people to buy health insurance, not that it would make purchasing a health plan the best economically-minded choice for everyone. Generally, the crafters of the law envisioned, people wouldn’t need a lot of prodding to get coverage.
So by now you see the opening that was left for opponents of the law: because the penalties for not buying insurance are low, people who are young and healthy are open to being persuaded to opt out of complying with the individual mandate and simply pay the penalty. If you can get enough young people to pay for the privilege of not having health insurance, then the whole thing falls apart. This strategy also has the added benefit that once you convince someone that they’re better off paying a tax than complying with a law’s requirement to be insured, they’re likely to grow to resent that law fairly quickly. After all, such people are paying the government to leave them alone.
Stepwise, it makes perfect sense. But if you move back a few steps and look at the broader picture, things start to look a little weird.
For example, this ad was put out by the group Generation Opportunity – which get’s much of its funding from the billionaire brothers and libertarian activists Charles and David H. Koch. I don’t like to personalize politics, but the spectacle of billionaire heirs spending boatloads of money to convince young people that they shouldn’t insure themselves against the risk of financial ruin is, to say the least, fascinating.
It’s similarly fascinating, and bizarre, to find the self-styled party of personal responsibility and the free market arguing against people purchasing healthcare from private providers. It’s one thing to say that the government shouldn’t force you to eat your vegetables, but it’s quite another to say that you shouldn’t eat your vegetables, period.
If, for a moment, you put aside the tactical question of how to most-effectively undermine Obamacare and instead ask the more strategic question of where the Republican party is going or the more existential question of what the Republican party stands for, you can begin to see why I would predict that the most fascinating future dissertation on Obamacare is going to focus on this effort in the states.
* * *
The Protestant Reformation ushered in a notoriously expansive sense of what constitutes idolatry. For Martin Luther, even scriptural literalism brought risks of mistaking the thing you were supposed to really care about – God, Christ, and the Gospel – with the thing you were using to think about it – i.e., the Bible.
Why do I bring this up? Because it might be time for the GOP to ask itself it it hasn’t made an idol of their opposition to Obamacare. And in the worship of that idol, conservatives have done a disservice to their gospel of limited government, personal responsibility, and free market discipline. When you find yourself trying to convince young people that health insurance is bad for them, you might have strayed too far from the straight and narrow.
Follow Pedro on Twitter @IamPedroA.
Want to help The Fog of Policy grow? Then take a minute and share this piece! Or let me know what you think in the comments section.
Have a question or suggestion for a new piece? Submit it through the Feedback form – and don’t forget to subscribe on the homepage to get posts and features automatically sent to your inbox.