The Obamacare Crisis

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The chaos surrounding efforts to activate HealthCare.gov reinforces a key conservative meme: that whatever the test is, government will fail it. Insofar as voters experience their interaction with government as frustrating and unreliable, the brunt of political damage will hit Democrats, both as the party of government and as the party of Obamacare.

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In addition, the Affordable Care Act can be construed as a transfer of benefits from Medicare, which serves an overwhelmingly white population of the elderly–77 percent of recipients are white — to Obamacare, which will serve a population that is 54.7 percent minority. Over 10 years, according to the Congressional Budget Office, the Affordable Care Act cuts $455 billion from the Medicare budget in order to help pay for Obamacare.

Those who think that a critical mass of white voters has moved past its resistance to programs shifting tax dollars and other resources from the middle class to poorer minorities merely need to look at the election of 2010, which demonstrated how readily this resistance can be used politically. The passage of the A.C.A. that year forced such issues to the fore, and Republicans swept the House and state houses across the country. The program’s current difficulties have the clear potential to replay events of 2010 in 2014 and possibly 2016.

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David Frum, a right-of-center columnist for the Daily Beast, recently pointed out in an article called “The Obamacare Ripoff,” that Obamacare poses dangers to Democratic support in the middle class.

“The Affordable Care Act was ingeniously designed to deliver benefits to Democratic constituencies and impose costs on Republican ones,” Frum wrote. “The big surprise in the ACA rollout is that this design is going awry. It’s not only plutocrats and one-percenters who will find themselves worse off; not only the comparatively affluent retirees enrolled in Medicare Plus programs.” These liabilities are becoming apparent in comments from regular voters.

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At his press conference on Nov. 14, Obama promised to try to resolve the problems of those facing cancellations, but he indicated that their concerns are not his highest priority:

So we’re going to do everything we can to help the Americans who have received these cancellation notices. But I also want everybody to remember there are still 40 million Americans who don’t have health insurance at all. I’m not going to walk away from 40 million people who have the chance to get health insurance for the first time. And I’m not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years.

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Obama has placed himself and his party in what now looks like a zero-sum bind, forcing a choice between inflicting the painful consequences of Obamacare on the electorate now or 11 months from now.

Politicians invariably choose to put off problems when they can. That means most of next year will be taken up by the administration’s struggle to protect the crown jewel of the president’s tenure without letting the roof collapse on his party.

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The Affordable Care Act “is often compared to Social Security and Medicare, but these comparisons are imprecise and misleading,” as Edward Carmines, a political scientist at Indiana University, put it in an email: “The distinctive feature of the new health care law is its redistributive nature, which is mostly absent from Social Security and Medicare.”

Carmines went on, succinctly analyzing the political problem lying at the heart of Obamacare:

Most of the benefits of the new program will go to the poor and less-well-off and most of the costs will be born by the well off. Neither is true of Medicare or Social Security. When the new law was passed it was hailed by The New York Times as the most redistributive policy in a generation, and they were right. It was not sold as being markedly redistributive, of course, but that is how it was designed and will operate. This does not mean it is a bad policy or doomed to fail. But it does mean that it was bound to be caught up in controversy and heated debate.