The tidings – for the US President if not for his political opponents – have suddenly and notably improved about the healthcare reform that bears his name. This month the administration announced that eight million people had signed up for the Affordable Care Act, aka Obamacare – a figure considerably higher than expected, and inconceivable six months ago, in the immediate wake of the botched debut of the government-run healthcare exchange central to the ACA, that threatened the law’s very survival.
Obamacare is nothing if not complicated, and it will be many months, if not years, before its performance can be reliably assessed. We do not yet know, for instance, how many of the eight million are newly insured, or have merely switched policy. Two things however are already clear. First, the ACA will reduce the shocking number of 48 million Americans who were without insurance in 2009, the year before the President signed it into law. By precisely how many it is impossible to predict, but it is already certain that Obamacare is the most significant expansion of US healthcare since Medicare and Medicaid, providing coverage for the elderly and the poor, were enacted half a century ago. And second, in some form or other Obamacare is here to stay, whatever the Republicans’ avowed determination to repeal it.
In democratic countries a welfare entitlement, once given, is virtually impossible to rescind, and the US is no exception. Even in the new law’s darkest hour last autumn, many elements of it were highly popular – including the bans on insurance companies refusing coverage for pre-existing conditions and imposing lifetime payment caps on their customers.Republicans have more or less conceded that these provisions will stay.
For the rest however, the party’s behaviour over Obamacare has been little short of disgraceful, and it is now starting to find itself in a well-merited bind. For all its bluster (the Republican-controlled House of Representatives has passed 40 or more bills repealing all or part of the law), it has come up with no credible, coherent alternative. Instead, the party has sought only to challenge, delay and thwart Obamacare at every turn, confident that voters would handsomely reward this strategy. The obstructionism has extended to Republican governors blocking the ACA-prescribed expansion of Medicaid in their states, thus depriving many poor people of coverage – even though this expansion would be totally paid for by the federal government. Such meanspiritedness is breathtaking, albeit predictable given today’s virulently conservative brand of Republicanism. But the electoral calculations may prove mistaken.
It is premature to suggest that Obamacare will be a winner for Democrats in November’s mid-term elections, at which they face the potential loss of not just the House but the Senate as well. Polls show the country remains divided over the law, while mid-term turnout is traditionally low; some 40 per cent compared with 60 per cent or more when the White House is at stake. Moreover, mid-term voters tend to be older, whiter and more affluent – not the younger, poorer and minority Americans who are more likely both to be Democrats and benefit from healthcare reform. But if the Democrats can mobilise this potential support six months hence, Obamacare will not be a political albatross after all.