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Conservatives Brace for the Possibility Obamacare Won't Totally Suck

Leaders of the Republican Party are still predicting that Obamacare will be a disaster, one that will wreak havoc on American health care. Most of their allies in the media say the same thing. But a small group of conservative intellectuals has been warning that the law might not be so apocalyptical—that, with full implementation about to begin, wholesale repeal may no longer be possible. That argument may be starting to sink in, if a new article in the Washington Examiner is indicative.

The article, “Are Republicans Fooling Themselves About Obamacare?,” comes from conservative writer and pundit Byron York. Here’s what he writes:

…a lot of thoughtful conservatives are looking beyond Oct. 1 to Jan. 1, the day the law (except for the parts the president has unilaterally postponed) is scheduled to go fully into effect. On that day the government will begin subsidizing health insurance for millions of Americans. (A family of four with income as high as $88,000 will be eligible for subsidies.) When people begin receiving that entitlement, the dynamics of the Obamacare debate will change.

At that point, the Republican mantra of total repeal will become obsolete. The administration will mount a huge public relations campaign to highlight individuals who have received government assistance to help them afford, say, chemotherapy, or dialysis, or some other life-saving treatment. Will Republicans advocate cutting off the funds that help pay for such care?

The answer is no. Facing that reality, the GOP is likely to change its approach, arguing that those people should be helped while the rest of Obamacare is somehow dismantled.

York goes on to predict that the law will hurt many more than it helps—and that the disparity might be large enough to sustain a political backlash.

...if on one side there are many millions of people paying more for coverage than they did previously, losing coverage they were satisfied with, and suffering through great uncertainty, while on the other side there are far fewer people receiving direct government subsidies — if that happens, then the political fight over Obamacare will intensify rather than fade.

But even if that happens, York concedes, Republicans probably couldn’t eliminate the subsidies.

York has this mostly right, I think. Once Americans can take advantage of the law’s benefits—once more low-income people become eligible for Medicaid, and once more low- and middle-income people start to get subsidies that will help them buy private insurance—taking those benefits away will be nearly impossible, particularly since Republicans still haven't proposed an alternative that would come close to providing the same level of security.

As for the idea that the people who benefit will be outnumbered by those who suffer, that's possible but highly unlikely. As we’ve seen in the intense back-and-forth over “rate shock” for young people, Obamacare critics tend to assume it’s a narrow, very poor group of Americans who will take advantage of the protection the law provides. But about 27 million people are going to end up on Medicaid or in the new insurance exchanges by 2017, according to the Congressional Budget Office. (Even more will end up on Medicaid if states refusing to expand their programs relent.) These people will be disproportionately low-income, but several million will be middle-income. As York properly notes, subsidies are available to people who make up to four times the poverty line, which is about $90,000 a year for a family of four and a lot more than the typical American family makes.

Yes, those numbers still represent a relatively modest percentage of the American population. There are many more people who get insurance from employers, Medicare, or other programs already in existence. And if these folks who already have insurance really experience difficulty, then a political backlash really will develop. But experts have said employers are unlikely to drop or change coverage dramatically because of the law, and surveys so far have suggested those experts are right. The law’s changes to Medicare don’t seem to be having a huge effect on beneficiaries, except to give them extra prescription coverage and free preventative care. Conservatives have predicted that Obamacare will make health care more expensive and harder to get in the future. Evidence of that is similarly hard to find. As a matter of fact, inflation has actually slowed and many experts believe the law is partly responsible for that. Note that the conservative predicitons, even if true, would likely take years (and maybe decades) to materailze.

Plenty of things could still go wrong in the immediate future, of course. Obamacare is not the law most of its supporters originally wanted. It’s less generous, more complicated, and less efficient. It also depends on skill and good faith from state officials, many of whom are actively hostile to it. (Steve Benen recently counted seven ways officials hostile to Obamacare are trying to sabotage it.) The online insurance marketplaces might crash when they go online; people who need guidance might not be able to find reliable sources of it; states might be slow to figure out eligibility for low-income supports. The list of potential problems goes on. For the most part, these problems will mean delaying help for people already having a hard time. They will not have much effect on everybody else. And while the media will highlight these stories—as they should—it will also have other stories to tell, about many millions of people getting the financial security and access to care that has long eluded them.

One more thought to consider: Obamacare remains stubbornly unpopular, defying predictions that people would feel better about the law once the initial legislative fight was over. But anytime pollsters have asked more detailed questions, more complicated public sentiments have emerged. Greg Sargent, who first flagged York’s column this morning, points to a new poll from National Journal that suggests the public is a lot more patient than the Republican leadership is:

Given the choice to either repeal the law, wait and see how it takes effect, or add money to aid its implementation, only 36 percent of adults picked outright repeal. More than half chose to either wait and see (30 percent) or provide more money (27 percent).

Nobody knows for sure how people will react to Obamacare, least of all me. And there’s a reason I leave predictions to the New Republic’s other Cohn—I was one of those people making sunny predictions back in 2010, when the law passed. But if public opinion really does come to accept Obamacare, then the debate moving forward will probably return to what it was before: An ongoing fight over whether to push funding up or down, and whether to modify the design of benefits, but not to take them away completely.

Jonathan Cohn is a senior editor at the New Republic. Follow him on twitter @CitizenCohn