The White House’s ‘long game’ on Obamacare

What happened

After a last-minute enrollment spike, the Obama administration announced that it had signed up 2.1 million people in private health plans and 4.4 million in Medicaid under the Affordable Care Act by the Jan. 1 deadline for coverage to begin with the new year. With the HealthCare.gov Web portal now operating effectively for most users, the White House began pressing its campaign to enroll millions more by the March 31 deadline to have health coverage in 2014 or pay a penalty. “We’re focused on the long game for March 31,” one White House official told Politico.com. Massachusetts’s experience in launching its similar Romneycare health reform in 2006, the official said, “shows that people come in at the end.”

Republican critics noted that the administration had fallen short of its original goal of enrolling 3.3 million in private plans by Jan. 1, and was a long way off from the target of 7 million Americans enrolled by March 31. The administration distanced itself from the 7 million figure, saying that number originated with the Congressional Budget Office, not the White House.

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What the editorials said

After an abysmal start caused by “an incompetent rollout and resistance from Republican politicians,” the ACA is finally on track, said The Washington Post. Millions of people who lacked insurance are now telling stories of finally seeing doctors for everything from precancerous moles to diabetes to gallbladder surgery. But “to work well,” the private insurers on the exchanges need to sign up millions more enrollees—especially healthy people under 30. It’s simply too early to tell whether those people will enroll.

Obamacare supporters shouldn’t be celebrating, said the Orange County, Calif., Register. About 4.7 million Americans had their old plans canceled, and while it’s not clear how many got to keep them under revised rules or switched to other plans, Obamacare has so far produced many losers as well as winners. Another group that “will have a hard pill to swallow” are healthier, middle-class Americans who don’t qualify for subsidies under the ACA, and have to pay higher premiums to provide affordable plans to the older and sicker.

What the columnists said

With millions protected by its provisions, Obamacare is now here to stay, said Jonathan Chait in NYMag.com. So the Republicans’ “gleeful predictions of imminent collapse” will now give way to indignant attacks on “the nefarious tactics used to make the law work.” Remember the predictions of “a death spiral” of soaring premiums if enough young people don’t sign up? Conservatives just realized that the ACA has a provision that will keep that from happening: $20 billion collected from a tax on insurers and employers that can be used to offset any insurance company losses for three years. The result: no death spiral, and more sputtering Republican rage.

Obamacare will be a failure despite these tricks, said Grace-Marie Turner in NationalReview.com. Enrollment numbers will likely remain low, because the plans are too costly for self-insuring members of the middle class. “Faced with paying premiums of $3,000 or more a year and carrying a $4,000 annual deductible, millions just won’t see the value in buying coverage.” Opposition to the bill will also grow as its “least popular provisions go into effect,” said Lanhee Chen in Bloomberg.com. In order to cut costs while meeting Obamacare’s mandates, insurers are strictly limiting coverage to small groups of doctors and hospitals. At this year’s midterms, Democrats will pay the price for Obama’s “misguided effort to remake the American health-care system.”

That makeover has just begun, said Noam Scheiber in NewRepublic.com. By complaining about insurance costs, deductibles, and limits on networks, Republicans are “playing into the trap Obamacare laid for them.” The ACA has begun creating a broad constituency for government-subsidized health insurance, and when people complain about its shortcomings, they’ll be demanding more coverage at lower prices. Over time, public pressure will force Washington to ramp up its role in the health-care sector, as we inevitably evolve toward what liberal Democrats have always wanted: a single-payer health system.