The implementation of Obamacare was a sadly botched job. Despite the unpopularity of the plan to force 48 million uninsured Americans to buy health coverage, within the first three weeks of the October start date nearly 20 million people attempted to access the healthcare.gov website to sign up for subsidised cover. But a string of IT problems frustrated even the most supportive and were grist to the mills of the Affordable Care Act’s many opponents. Nor were the travails restricted to technicalities. President Obama’s repeated pledge that existing insurance-holders would not be affected proved to be untrue, provoking outrage and accusations of deliberate deception.
All of this took a very real toll on the President’s credibility. In a second term, even the heftiest incumbent’s power swiftly starts to ebb. For Mr Obama, already battered by the national security revelations from Edward Snowden and vacillation over Syria’s use of chemical weapons, the near-collapse of his defining domestic policy burned through much of what political capital he had left. With mid-term Congressional elections more than a year away, Mr Obama was already looking like the proverbial lame duck.
Since then, much ground has been made up. With Monday’s deadline for registration looming, some six million people have now signed up for insurance, shy of the original seven million target but in line with predictions revised to account for the IT problems.
Many issues are yet to be satisfactorily resolved. It is far from clear whether the young and healthy are enrolled in sufficient numbers to pay for the older and sicker. It is also uncertain how many of the registered will actually go on to pay their premiums. And, even with the recent burst of activity, only a fraction of those who could enrol have done so.
Progress is progress, however, and for all its glitches and shortcomings, Obamacare is progression. For a country as rich as the US to be home to so many millions who cannot afford to be ill can only be a question mark over its claims to be a civilised society. With support for the scheme continuing to slide, Mr Obama may struggle to overcome the drag. But his achievement is a historic one all the same.