HELENA – Seven weeks into the roll-out of the “Obamacare” marketplace and other key elements of the president’s signature health care law, I think we can all agree: It’s one colossal screw-up by the Obama administration, and could end up sinking the whole law and his presidency.
Team Obama is struggling mightily to right this ship, but once large parts of the public start doubting your credibility and competence, it’s hard to recover. Just ask George W. Bush and Jimmy Carter about that one.
Can Obamacare be patched up and made to work as its supporters imagine? I wouldn’t even venture a guess at this point. But before we address that question further, let’s consider a couple of things about the law, its intent and its politics.
For starters, the botched online marketplace and individual and small-group policy cancellations in the news affect a relatively small sector of the population and health insurance market.
In Montana, only 55,000 people are covered on the individual market. State insurance regulators estimate about half of them – 26,000 – received or will receive notices saying their current policy is being discontinued, and that they must buy new policies that comply with the Affordable Care Act (Obamacare).
The president is saying those policies now can be extended, although we’re not sure yet that will happen in Montana.
If it doesn’t, some people will end up paying more for a new policy. However, some also should be able to shop the online marketplace – if it ever works – and find a new affordable policy and, perhaps, one that is discounted by a subsidy.
People without health insurance, such as those who couldn’t afford it or who had pre-existing health conditions that got them rejected by insurers, also now are supposed to be able to shop for policies on the online marketplace. In Montana, this group could be as many as 100,000 people.
Some who are insured by small-group policies also may be affected by Obamacare in some way, such as having their employer drop coverage, pushing them onto the marketplace.
So, at most, 15 percent to 20 percent of Montana’s population could be directly affected by the fumbled roll-out and accompanying regulations. That’s no small amount of people, but it still leaves at least 80 percent largely unaffected and insured, covered by the likes of large-group policies, Medicare and Medicaid.
The president also said last week the screw-up is “on me.” Yes, it is. But Republicans should share the blame, too.
It’s true that Republicans didn’t vote for Obamacare, opposed it from the beginning and said it wouldn’t work.
It’s also true that since the law was passed by Democratic majorities in Congress, most Republicans and their allies have tried relentlessly to undermine, sabotage and undo the law, and, in many cases, spread misinformation about it.
Take the online marketplace in Montana, for example. Insurance Commissioner Monica Lindeen, a Democrat, asked the 2011 Legislature to authorize the state to design and run the marketplace. She had the support of major health insurers and agencies, many in the business and medical community and consumer advocates. The Republican majority in the Montana Legislature said no.
That left the federal government to build and operate Montana’s online marketplace. It’s been a disaster so far.
States that did design and run their own marketplace haven’t been a paragon of efficiency, but many are doing better than states that defaulted to the federal website. Montana could have been one of the former, giving its citizens a better chance to shop for private and possibly discounted insurance.
Republicans also have pretty much refused to help fix problems with the ACA, instead saying the only answer is to repeal it.
Amid all the political noise over the ACA, it’s worth repeating the goal of the law: To expand health coverage to the 50 million Americans without it, and improve private and public health insurance, and medical care in general, while it accomplishes that goal.
I doubt many among us think these goals are unworthy. The question becomes, can the ACA accomplish those goals, and at what cost – and does it deserve a chance to succeed?
That’s where the president and his supporters have to sell the public on this thing – and I’ve always thought it was a pretty tough sell.
Yes, the ACA helps the poor and the unhealthy get insurance coverage (although even that’s somewhat in question, with the messy roll-out of the marketplace and the lack of Medicaid expansion in many states) and has some protections for insurance consumers.
But, for most of us, we’re still paying dearly for medical care and health coverage, still dealing with a maddeningly complex and expensive system, and paying, indirectly or not, for the costs of Obamacare.
If the president and ACA supporters can’t convince us – or, more importantly, show us – that the law is somehow benefiting a majority of Americans, then public support will continue to flag. Without public support, the ACA is doomed, and could take years to unravel.
Obama and friends had better hope they get things fixed, and change the narrative. It won’t be easy.