Between now and the 2014 elections some of the problems with Obamacare will be corrected, some will persist, and some will grow in the public's awareness. The good news for Republicans is that the real problems are not solvable and that they are concretely affecting millions of Americans. More or less in order of fundamental importance:
1. The challenge to the consitution. (Most important, but of limited public interest.)
- The Supreme Court has said that it is OK to force citizens to purchase services that they do not want from private companies. That is a terrible precedent, but it has been fully litigated.
- The president has declared that he can ignore legislation that he does not like. He has done this on immigration (not deporting children of illegal immigrants), and on environmental controls (shutting down coal fired plants), but the abuse under Obamacare has gone much further - exempting unions; delaying the mandate for corporations, and now delaying enforcement on individual policies for a year. Conservtives howl, but for most voters the Constitutional division of power between the executive and legislative branches it is an abstract concept.
2. The loss of existing insurance and doctors. (Important and will continue to grow.)
- Some 5 million individual or small business insurance policies have been predictably cancelled with uncertainty growing with every White House misstep. Through 2014 the number of companies deciding to discontinue insurance for employees will grow through the year with a wave of tens of millions of announcements for 2015 coming out just before the elections. Little reported is the required scrapping of inexpensive student health care policies usually offered by colleges and universities.
- With the reduction in Medicare reimbursement rates and cost pressures on insurance companies forcing the elimination of higher priced doctors, thousands are retiring or moving to "consierge" practices. Insurance plans being offered also restrict the number of included hospitals, frequently those offering specialized services including care for children.
- President Obama's repeated, unequivocal promises that this would not happen will have lasting effect across a broad range of issues.
3. The cost. (Important and will continue to grow.)
- Insurance companies which based 2014 rates on an assumed participant pool including forced younger, healthy members will have many fewer of those "invincibles", yet will need to cover Obamacare's expanded offering, preexisting conditions, and kids through age 26. Rates for 2014 will have some adjustments, and the 2015 rates - to be published in October 2014 - will need to make the companies whole.
- Policies offered under Obamacare generally have significant deductibles. Unsophisticated buyers will experience sticker shock throughout 2014 as they find that the free lunch isn't completely free.
- Government costs will be above projections - for website work, for marketing, for reimbursement of insurance companies where individual costs exceed agreed limits. When Republicans and Democrats reconvene in January for the next round of debt ceiling and budget discussions no quarter will be given.
- There is no real capability or plan to verify individual reporting of income, and therefore eligibility for subsidies. Fraud; fraud; fraud.
4. The jobs impact. (Will continue.) Millions of workers will continue to be held below 30 hours per week and small companies will continue to hold employees below 50 in order to avoid Obamacare requirements. The economy will continue to drag.
5. The loss of privacy. (Will become more obvious, although not too important to many voters.)
- The website design does not contain fundamental protections aganist hackers seeking Social Security numbers, income information, and health records.
- Health and Human Services is spending about $67 million on 50,000 people with non-profits and community organizations to help people "navigate" the sign-up process, requiring access to personal financial and health records to determine what subsidies are available and matching needs to policies. ACORN redux.
- To bypass the constipated government system, people may be allowed to work directly with insurance companies, requiring them to have access to health and financial records.
5. The web site. (Will be fixed long before the 2014 election.)
- Barack and Kathleen promise the web site will be fixed by December 1. Well maybe 80% fixed. Well at least the English version. Well the the back end payment of insurance companies may come later. But they're working on it day and night. And it's really the fault of the government procurement system anyway.
Conservatives are lucky. With a competent executive - in the White House or at Health and Human Services - we would have had an endless cacophany of praise for the realization of decades of liberal dreams. The greatly increased cost of insurance for the middle class would be downplayed while the free care for the lower class would be trumpeted. The web site debacle and Obama's blatent misrepresentations upset that apple cart.
The impact beyond 2014 is uncertain, but it is most likely substantial. Conservatives have a tendency to talk about principles; liberals have a tendency to talk about real people. With Obamacare, millions of Americans are having direct personal experience with both the planned redistribution of wealth from the middle class to the lower class and the limitations on the ability of government to deal with the complexity of American society. For a generation we will have a simple widely understood codeword for that failure - Obamacare.
This week's video is Nancy Pelosi urging Democratic Congress members to campaign on their support for ObamaCare. Go you girl.