If it worked well, his name would always be attached to it. But what if it turned out to be a mess?
On the plus side, the ACA is a serious attempt to provide health insurance to tens of millions of Americans and to close some of the loopholes that allowed insurers to cherry-pick the market by, for example, refusing to insure those with pre-existing conditions.
But the negative side is overwhelming the good.
What’s wrong with the ACA, aside from the obvious failure of the online system for signing up for coverage?
Because of the way it was adopted, it is a complex and cumbersome method of extending coverage. It squeaked through Congress without a single Republican vote even though then Maine GOP Sen. Olympia Snowe might have been willing to support it with some changes.
To pass it, the Democrats had to forego necessary changes to the bill for fear that further debate would allow the Republicans to kill it. The lack of good leadership in either congressional party produced an unfinished law.
And Obama, as usual, seemed not to be a factor at all.
In Congress, there was not enough support for a single-payer system. Instead, the ACA is based on the theory that competition among insurers could produce results similar to governmentonly insurance elsewhere in the world.
The public-private plan is not working well. In some states, including Maine, there are few competitors, meaning there is little choice and no real cost reductions.
That means that one of the key promises behind the ACA, that it would lower ever-increasing health care costs, is not being realized. In fact, some insurers boosted their rates before the law went into effect.
And one choice –“If you like your current policy, you can keep it” – is not possible if it doesn’t meet ACA standards. This was Obama’s key promise to ease transition to the new system, but the promise was not kept.
The principal reason for health insurance reform was to expand coverage to almost all of the uninsured. But that could only happen if the states went along with the expansion of Medicaid, and over half have refused.
Obama and the Democrats, faced with relentless Republican criticism, failed to explain and promote the ACA. One of the main reasons the 2010 elections produced such success for the tea party movement was the success of its unanswered attacks on it.
The failure of the computerized system for signing up for insurance suggests Obama and Kathleen Sebelius, the secretary of Health and Human Services, thought the hard work was mostly done when ACA was adopted.
Not only did they fail to inform the public, but they allowed the system to be developed without sufficient supervision and competent management. Sebelius says she accepts responsibility. What does that mean, if she’s not fired?
The damage caused by this vulnerable, patchwork program and its mismanagement goes far beyond the ACA mess.
Republicans have continuously attacked it, because they oppose any increased role for government, even in this hybrid publicprivate plan.
A successful roll-out would have refuted their argument about government’s inefficiency. That’s why the GOP made a lastditch effort to defund it, just before the October 1 launch for signing up.
Their failure to defund it was coupled with the government shutdown they forced. Voters opposed defunding and the shutdown.
Obama and Democrats began to look at the possibility of the 2014 elections giving them the ability to regain political control in Washington. The ACA fiasco may have flipped the situation.
The president seems to have lost his self-confidence, hoping that if the system begins to work properly, people will forget this year’s problems.
The ACA is beyond outright repeal, because its ban on refusing coverage for pre-existing conditions and extending coverage for young people on their parents’ policies are in effect.
Instead of the ACA’s momentum pushing GOP leaders to negotiate improvements, they maintain their steadfast opposition. More voters may come to agree with them.
Hardcore conservative Tea Partiers, favoring repeal without proposing a viable alternative, may now stand to gain in next year’s elections, rather than losing ground to more traditional Republicans. That’s the recipe for more Washington deadlock.
Ideally, both sides should agree to a short delay and a formula for fixing the defects in the ACA.
Realistically, that won’t happen, and the ACA debacle may influence American politics for years to come.
GORDON L. WEIL, of Harpswell, is an author, publisher, consultant and former public official.
Comments are not available on this story.
Send questions/comments to the editors.
