Conventional wisdom states that there are still big potential obstacles in the path of successfully implementing ‘Obamacare’, key parts of which go into effect at the end of 2013. And there’s no question that the implementation process is a mammoth one. But Theda Skocpol says most of those threats are being hyped way out of proportion …
I very much appreciate your continuing coverage of the ObamaCare implementation issues, especially the decisions various Republican governors and legislatures are taking for now. But on this latest about four reasons why ObamaCare might “fail” let me demur — as an expert, along with Lawrence Jacobs, who not only has studied and written a widely used book about health reform’s enactment and early implementation but is also continuing to research the various paths in the fifty states.
There is WAY too much doomsaying about all of the twists and turns. How many times has the blogosphere declared ObamaCare dead? Or claimed that some development, such as the grant to the states of authority to accept or reject components, would prove fatal? Experts like Jost and Gruber are implicated in overhyping too. Jost is a legal expert. Gruber an economist. Both are experts in their domains, but not in politics. Neither seems to understand the relatively protracted political contention that accompanies big expansons of the U.S. welfare state like this one. Social Security was opposed by the GOP for fifteen years after enactment, and came close to fiscal death various times. Medicare was very ideologically fraught for years. (Both have been revived as partisan battles lately.). But these programs have all survived, and so will ObamaCare.
Public opinion has always been partisan divided on the reform overall, but the key components have almost all been and remain very popular. They are coming into concrete existence in states with at least half the national population. A number of GOP governors have already blinked on rejecting Medicaid expansions, and others will — plus more will be defeated in 2014 (e.g., in Maine, where the legislature is ready to move ahead, and probably in Florida, too). Even the exchanges are getting quiet cooperation in various refusnik states, and there are advantages to some degree of national standardization in the exchanges, for which the federal government is now widely responsible. (Back when ObamaCare was passed into law, liberal bloggers were declaring doom over the fact that fifty states would have to design exchanges; now doom is being declared over the fact that half the exchanges will be strongly shaped by the feds. Which is it? Or is it just perpetual doom?)
This will be a long and contested process, but there is no prospect whatsoever that this law will be repealed or permanently thrown off track. Yes, the GOP will cut back vital funding if it gets windows, but those windows will not be likely to last. Before long, moreover, supporters will be able to point to real, popular gains in wellbeing in a lot of states — and ask why the laggard or refusnik states are denying these to their citizens. At the very least, bloggers and center-left news outlets ought to be pointing to the positive policy and political possibilities, not just declaring doom again and again.
Number four on your list is a serious problem. The rest are interim or overhyped. And number five is this: too much doomsaying among liberal media people.