2014: Another Election About Obamacare

December 23rd, 2013

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Here we go again.

2014 will be the third election in a row in which Obamacare is the central issue. The Affordable Care Act, which President Barack Obama signed into law in March 2010, contributed to a fierce voter backlash against Democrats in November 2010. After the Supreme Court upheld the law in June 2012, the issue seemed to be settled by Obama’s re-election that November.

But no.

The botched Obamacare rollout this year has again thrust the issue to the top of the political agenda. Republicans are counting on opposition to Obamacare to propel them to a majority in the Senate next year. A conservative group is already running an ad attacking Senator Jeanne Shaheen (D-N.H.) for supporting Obamacare: “Next November, if you like your senator, you can keep her. If you don’t, you know what to do.”

2013 came to a close with two big political stories. The government shutdown in October was immensely damaging to Republicans. So damaging that House Republicans defied their conservative base and voted for a compromise budget deal last week. Speaker John Boehner (R-Ohio) attacked the Tea Party, accusing them of pushing congressional Republicans “into this fight to defund Obamacare and shut down the government.” A fight Boehner said all along was unwinnable.

The message was, “No more shutdowns.” Republicans didn’t want to step on the second big political story, one immensely damaging to Democrats: the rollout of Obamacare.

While both parties were damaged by the year-end stories, the headline in the Washington Post last week was, “Obama suffers most from year of turmoil, poll finds.” The Democrats’ Obamacare disaster trumped the Republicans’ shutdown disaster.

The problems with Obamacare are likely to continue into 2014. The problem is that the young and the healthy are not signing up in anything close to the numbers needed to subsidize insurance coverage for the old and the sick. The incentives are not strong enough. Young people are convinced they are immortal. They don’t expect to get sick. Or to have a car crash — the leading health risk for young people.

The law says they have to spend $100 or $200 a month for health insurance or else pay a fine. How much is the fine? For the first year, $95. When do they have to pay it? In April 2015. Which sounds to them like the distant future.

Many young people will be willing to risk the fine and use the insurance money to buy a car. Or go to Cancun and party their brains out.

The New York Times and CBS News just polled uninsured Americans and found them highly skeptical of the Affordable Care Act. Among the uninsured, 53 percent say they disapprove of the new law. The poll found about the same disapproval among the insured (51 percent). Only a third of the uninsured believe the new law will actually help them.

There’s another problem. Many small businesses are being allowed to extend their employees’ current health insurance plans through next year. In October 2014 — a month before the election — insurance companies will notify those employers of the new premiums they will have to pay under Obamacare. In many cases, those premiums will go up. Way up. They may have gone up even without Obamacare, but any rate increases will be blamed on Obamacare. As one expert put it to Politico, “You own all the changes when you put in new rules.”

The Affordable Care Act does require more comprehensive coverage than many small business plans now provide. Companies that have younger and healthier workers will have to share the cost of covering firms with an older workforce. The Obama administration promised that the vast majority of workers with employer-based insurance would not be affected. That is almost certainly true. But the minority who see their premiums shoot up next year will complain. Loudly.

It’s the same thing that happened with people who had their individual policies canceled this year because they did not meet the Obamacare standards. Those people claimed they were betrayed because of Obama’s 2010 pledge, “If you like your insurance plan, you will keep it.”

“The way I put that forward unequivocally,” the president acknowledged last month, “ended up not being accurate.”

Very few Americans actually faced cancellations — because very few Americans purchase individual coverage. But those who were affected complained. Loudly. And those complaints made a powerful impression on the larger electorate.

Millions of Americans are benefiting from Obamacare. They are getting health insurance they could never get before. The working poor in many states are becoming eligible for the expanded Medicaid program. A lot of people, particularly women and older Americans, will see their coverage expanded and their premiums go down.

They are not being heard from, however. In the Times-CBS poll, only a third of the uninsured said that, when they evaluate their member of Congress, his or her position on Obamacare “will matter a lot.”

The Democrats’ challenge is to rally people who are being helped. That will not be an easy task. Satisfied people rarely make a lot of noise in politics — unless they feel threatened. The Democrats’ task in 2014 will be to dramatize the threat that a Republican Congress would pose to Obamacare.

The Affordable Care Act was passed nearly four years ago. But the struggle is still far from over.

This piece was originally published via Reuters.