HEALTH INSURANCE

Obamacare’s rocky beginnings

 
 
GERSON
GERSON

michaelgerson@washpost.com

In one of the few political jokes attributed to a physicist, Ernest Rutherford once described a public official as being “like a Euclidean point: he has position without magnitude.”

With a change of pronoun, he could have been describing Secretary of Health and Human Services Kathleen Sebelius, who ignored internal warnings about flaws in HealthCare.gov, botched its rollout, minimized her involvement and blamed her contractors. Now, in congressional testimony, she has accepted responsibility without the inconvenience of accountability or the demonstration of competence.

Administration incompetence is not the final word on Obamacare, but it is the initial impression. In the realm of branding, the Affordable Care Act, so far, bears less resemblance to Britain’s popular National Health Service than it does to the local department of motor vehicles. This may be temporary. But it is not politically insignificant that the largest recent expansion of government should exactly confirm the worst stereotypes of government.

For the Obama administration, however, the consequences of incompetence are not only ideological.

Any vastly ambitious law produces winners and losers. The losers, in this case, include millions of people who currently have what Obamacare regards as the wrong sort of insurance — not comprehensive enough to cover, say, prescription drugs or pediatric dental care. These citizens are losing coverage because the government no longer approves of the product they are buying, forcing them to purchase a different — and often more expensive — product instead.

Eventually there will be other losers: people dropped from full-time to part-time employment to skirt Obamacare mandates, people forced out of private coverage into Medicaid, people who live in rural areas where the choices in the exchanges will be limited.

Obamacare has winners as well; particularly those with pre-existing conditions and young adults who want to stay on their parents’ health insurance. The problem for Democrats right now is that the winners can’t be effectively highlighted. The administration had hoped to spend November and December countering stories about the losers with positive, emotional stories of people with cancer or some other ailment finally getting coverage. The administration’s incompetence has made this impossible. Instead, it has gotten headlines like this one from NBC News: “Obama Administration Knew Millions Could Not Keep Their Health Insurance.”

The case for Obamacare was never going to be easy. The program was sold as a middle-class benefit but it actually benefits a subset of the middle class. Federal subsidies go up to 400 percent of poverty — $45,960 for an individual — with much larger help at the bottom than the top. The law also mandates that younger and healthier people purchase comprehensive coverage. So the program benefits older, lower-middle class people while placing new burdens on younger, upper-middle class people. Like elsewhere in the welfare state, the young come out behind.

So there is a serious gap between the simplicity of the message that sold Obamacare and the complexity of the law’s outcomes. And the karmic consequences for the president and his party are considerable.

• First, Obama’s credibility is undermined. “If you like your healthcare plan,” he said, “you will be able to keep your healthcare plan. Period.” It was the most emphatic, unqualified, high-profile public policy promise since “Read my lips” — and its violation is at least as discrediting.

• Second, Democrats have muddied their central political appeal of siding with the middle class. Some in that large, elastic category will come out ahead. Others will see their premiums dramatically increase without qualifying for subsidies. One self-employed pregnant woman who has recently lost coverage is quoted in the Los Angeles Times: “It doesn’t seem right to make the middle class pay so much more in order to give health insurance to everybody else.” Democrats will be forced to answer: It depends on what you mean by middle class.

• Third, these challenges are beginning to divide the Democratic coalition. Many unions, already unhappy about Obamacare fees on group plans, are not rallying to defend the law. And many Democratic politicians will be tempted to distance themselves from Obamacare as dysfunction extends from weeks to months. This face plant, after all, took place on the first hurdle. It is far from clear whether the exchange risk pools will be large enough and diverse enough a year from now to work properly.

These last few weeks offer some hard lessons for Democrats: Those who pass a partisan health law, own it. And those who believe in government are not necessarily capable of running one.

Michael Gerson’s email address is michaelgersonwashpost.com.

© 2013, Washington Post Writers Group

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