An Obamacare Counterfactual
In politics and football, there is no position easier to play than Monday morning quarterback. So now that the defund Obamacare gambit has failed, let’s contemplate an alternative scenario.
When the Obama administration announced in early July that it would delay the employer mandate, Republicans might have proposed delaying either the individual mandate or the rest of the Affordable Care Act in its entirety. The House did pass the former, with the votes of 22 Democrats.
Even as late as the shutdown, nine Democrats voted with Republicans on delaying the individual mandate. West Virginia Democratic Sen. Joe Manchin signaled he would be willing to support the idea. Republican leadership floated just such a proposal at various points.
Consider a three-month campaign in which Republicans were united behind a delay, rather than splintered over various anti-Obamacare strategies. Public opinion would have been on their side. Perhaps more Democrats would have been won over and the president would have felt political pressure.
But for the sake of argument, let’s say the president and most Democrats held firm. Imagine if instead of tying delay or defund to the continuing resolution and inviting a government shutdown, the Republicans allowed a clean spending bill to pass on Sept. 30 (understandably without the votes of many conservatives). Oct. 1 comes and the Healthcare.gov roll-out is a disaster, as Ted Cruz and the rest of the Republicans had predicted.
At that point, Republicans could keep making the argument that if corporations were getting a reprieve from Obamacare, so should the rest of us. There would be no government shutdown to distract from the real-world examples of increased premiums and massive technical failures. While delay, just like defunding, would ultimately require Democratic assent, at least the whole debate would have been conducted on terms more favorable to Republicans.
Now let’s bench the Monday morning quarterbacks and get back into the game. Republicans could get another chance to push for delaying the individual mandate or other substantial parts of the law—if they are willing to take it.
While the federal government has yet to release its official figures, the numbers trickling in from the states suggest Obamacare enrollment is painfully low. South Dakota and Alaska appear to have initially enrolled just 30 people combined. The Associated Press is reporting that about 476,000 health insurance applications have been filed through federal and state exchanges, which suggests that the number actually enrolled is lower than that.
Perhaps this is but a bump in the road toward the seven million who were projected to gain coverage during the six-month sign-up period, considered by many experts to be the minimum number required to make the exchanges viable. But even some Obamacare supporters have begun to weigh the possibility of delay.
“[I]f we get to December without fixing the website problems, then some version of what conservatives have been demanding—a delay of the individual mandate—actually makes sense,” writes New York magazine’s Jonathan Chait.
Does that mean some version of Obamacare delay could be back on the table? Liberals might accept a delay adjusted for states that have poorly functioning exchange websites, or based on decisions that, as Chait puts it, “rest with the Department of Health and Human Services, or some other body that is trying to make the law succeed, not one that’s trying to destroy it.”
This brings us to a dilemma: pro-delay conservatives are still trying to fully repeal Obamacare while pro-delay liberals hope to fix it. No matter how bad Obamacare’s implementation looks, many liberals would be reluctant to makes any concessions to people who want to get rid of the law. And many Tea Party conservatives will say “let it burn” rather than making common cause with those looking for repairs.
But people who want to repeal Obamacare and people who would like to fix it have worked together before. They cooperated on repealing the onerous and absurd 1099 reporting requirements, a repeal bill actually signed into law by President Obama. Some are united on repealing the employer mandate, an idea backed by Republicans in Congress and liberal policy wonks outside it.
Obamacare fixers and Obamacare repealers joined together earlier this year in the Senate to try to get rid of the medical devices tax, through the proposal became a victim of House brinksmanship and misguided populism in the most recent standoff.
The reasons liberals should want to prevent their long-awaited victory on health care reform from being turned into defeat by the haphazard implementation of a poorly constructed law are obvious. But what’s in it for conservatives? Nothing would better vindicate their case against Obamacare than the “death spiral” that would follow young people fleeing exchanges that are being flooded with the old and sick.
Yet if Obamacare undermines the entire individual health insurance market, it will make it even more difficult—and perhaps impossible—to ever implement any free-market health care reforms. In fact, single payer may loom ever larger as the only viable remaining option to an employer-based system that both conservatives and liberals would like to substantially remodel.
Some kind of delay would buy conservatives more time to work for repeal and, hopefully, make the case for free-market alternatives. It would give liberals a chance to fix Obamacare. And whatever each side believes about the other’s motives, the deal makes sense according to what they each say they believe about Obamacare.
The administration may be relying on an Obamacare tech “surge.” But Republicans and Democrats would be wise to negotiate a tactical withdrawal instead.
W. James Antle III is editor of the Daily Caller News Foundation and author of Devouring Freedom: Can Big Government Ever Be Stopped?