We are on the eve of a potentially life or death moment for the Affordable Care Act, otherwise known as Obamacare.
The stakes are high for the Republicans and for President Obama, who is preparing to spend the remainder of his term as the lamest of lame ducks if his signature piece of legislation totally collapses. Based on the latest information pertaining to the condition of the website and public opinion among other things, the demise of Obamacare is much more of a possibility than it has ever been. That being the case perhaps it would be interesting to examine the landscape for all of the stakeholders going forward.
Obviously, the President himself has the most at stake here. His sincere job at overeager salesmanship in promising that all could keep their insurance plan if they were happy with it has proven to be the icing on the moldy, bitter rollout cake. The lack of a working website to be embraced as the alternative to one’s existing insurance plan has spawned panic among those on the edge who had planned to grab the Obamacare lifeline. A complete failure to right the Obamacare ship will doom every initiative left on the President’s agenda and send the already paranoid Democrats into a pell mell, everything man and woman for themselves stampede. On the other hand, if President Obama manages to snatch victory from the jaws of defeat he will likely return to the healthcare hero status that he once occupied.
Lately, the Republicans have found it impossible to avoid breaking out into preliminary end zone dances. It is becoming more obvious that their protracted efforts at massive resistance to the Affordable Care Act may indeed result in the collapse or the outright repeal of the law. Republican euphoria is palpable. The word one hears increasingly is “alternative,” as in what is the Republican alternative in the event of the demise of Obamacare? So far no alternatives have been forthcoming. However, we may not be far away from revisiting a rejected Republican package containing tort reform, the marketing of insurance across state lines and vouchers for defraying the costs of buying traditional health insurance policies. Will this be viewed as a Republican victory with a tangible political payoff or after the dust settles will Republicans be in for the lion’s share of blame for the demise of yet another failed effort at expanding health care coverage for millions of uninsured or under insured Americans? If the latter is the case what will be the political price to be paid by the GOP?
In the postmortem the roles of insurance companies will come under scrutiny. Will they have been willing participants in the fullcourt press to bring down Obamcare or will they have simply let uncertainty freeze them in place in the face of any effort they may have made to contribute to a solution? What is at stake here is a test case on whether insurance companies can be willing collaborators in the next effort to expand coverage. If the answer is “not likely,” the advocates of a single payer system may draw closer to carrying the day.
Then there is the insurance buying, object of illness — the general public. Virtually all of the opinion polls indicate that the majority of this most crucial of groups has lost confidence in the Affordable Care Act as a solution to their health care problems. It can only be assumed that the collapse of Obamacare would return things to the previous condition as far as the relationship of the public and insurance providers is concerned. As the policymakers depart the scene they will once again be replaced by the actuaries. Premiums would resume being calculated based on lifetime caps, the ability to raise premiums when illnesses occur and the denial of coverage in the cases of pre-existing conditions. Services such as mammograms, colonoscopies and birth control would return to a cash-only basis.
Ultimately, where will blame come to rest? Certainly the larger portion of blame will be directed toward the Obama Administration. This will be so not because the effort was made at creating a national health care program. Indeed, success would be greeted by virtually universal joy at the discovery of a workable solution to one this nation’s most vexing problems. The blame will be based on the appearance of incompetence in the design of policy implementation, thereby resulting in a fabulous opportunity lost.
In all likelihood, a significant measure of blame will redound to Republicans also who will indeed be able to claim success at thwarting the legislative crown jewel of the Obama presidential administration. Will a public who finds itself back at square one as far as health care is concerned share their joy, or will they place the GOP in the same category as those who failed at implementation?
The irony is that the Republicans could steal a major Democratic party victory by offering a workable alternative or perhaps by merely coming to the table with solutions to save the existing legislation. The likelihood of such a turn of events appears to be slim. In that case the public is the loser and there is ample blame to go around.
» Dr. William Martin Wiseman is director of the John C. Stennis Institute of Government and professor of political science at Mississippi State University. Contact him at firstname.lastname@example.org.