I haven’t been writing about the HealthCare.gov discussion in the United States for the simple reason that I have nothing to say. The uproar isn’t over a policy question: we know from the states with functioning insurance exchanges that the underlying structure of the Affordable Health Care Act is workable. Instead, it’s about an online implementation botch, which is an incredible mess, and reflects very badly on President Obama.
The future of the reform depends not on policy per se but on whether the information technology issues can be fixed well enough, soon enough — a subject about which I have zero expertise. Of course, a lack of expertise hasn’t stopped other people from breathlessly commenting on every twist and turn in the polls, every meaningless vote in the House of Representatives, and so on. Hey, it’s a living. But at this point there’s enough information coming in for me to make some semi-educated guesses — and it looks as if this thing is probably going to stumble through to the finish line.
State-run enrollments are mostly going pretty well; Medicaid expansion is going very well (and it’s expanding even in states that have rejected the expansion, because more people are learning that they’re eligible.) And HealthCare.gov, while still pretty bad, is starting to look as if it will be working well enough in a few weeks for large numbers of people to sign up, either through the state exchanges or directly with insurers.
If all this is right, then by the time open enrollment ends in March, millions of previously uninsured Americans will in fact have received coverage under the law, and the reforms will be irreversible. Mr. Obama may never recover his reputation; Democratic hopes of a wave election in 2014 are probably gone, although you never know. But anyone counting on Obamacare to collapse is probably making a very bad bet.
News Cycle Delusions
Let me say something about the planned Republican attack on Obamacare — not original, but maybe blunter than you’ll read elsewhere. Here it is: They’re fools. Consider two possible states of the world. In one, the technical disaster of Healthcare.gov proves so intractable that by March 31, when open enrollment ends, the program fails to launch. In that case, Democrats will suffer a crushing defeat no matter what Republicans do. In the other, which looks more likely, the enrollment process becomes sufficiently workable, to the point that by March 31 millions of people who previously lacked health insurance or had more or less worthless insurance policies have acquired real coverage.
In that case reform will be irreversible, the Republicans’ scorched-earth opposition will turn into a political liability, and it will be a political win for Democrats — not as big a win as if the thing had worked well from the start, but still a win. Nothing else matters. Republicans can win every news cycle for the next month and nobody will remember it in a year.
The only thing the G.O.P. can do that could have any real impact would be to sabotage the law. And they’re doing that as best they can by blocking the expansion of Medicaid, the government-run health program for poor Americans. But if the exchanges begin to work even passably well, that won’t be enough — when people, including the young, realize that real insurance is available at affordable prices, political propaganda won’t keep them away.
Of course, I could be wrong. Maybe the I.T. fix will be much harder than us nongeeks imagine. But one thing’s for sure: The GOP’s spin offensive will matter not at all.