Can the Democrats Be the Party to Fix Obamacare?

Washington DC 2

The future of the Affordable Care Act is stabilizing; President Barack Obama knows it and Republicans facing reelection or challenging Democrat incumbents in November’s midterm congressional elections are beginning to realize it as well. In the four years that separate the signing of the Affordable Care Act in March 2010 with the conclusion of the first enrollment period for the Obamacare-created insurance exchanges at the end of last month, the Republican party has little changed its stance on the the health care reform, and repeal has always been a top priority of the GOP-controlled House of Representatives. Republican lawmakers have attempted nearly fifty times to repeal, defund, or mitigate the impact of the law. But, with 8 million potential voters enrolled for coverage through the exchanges, the party’s repeal efforts have been complicated.

Across the board, repeal appears to be an untenable position for the Republican party. In November’s elections, in which Obamacare will undoubtedly be a major issue, Republican candidates will have to earn votes from people for whom repeal means the loss of health insurance coverage. A recent poll conducted by the Kaiser Family Foundation suggests that approximately half of Americans — including 25 percent of Republicans — would prefer to modify the health care reform law rather than repealing it. And, logically speaking, no veto-proof repeal of the Affordable Care Act could take place with President Barack Obama in office, even if the Republican party takes control of the Senate as political analysts are predicting.

This is not to say that the most fundamental tenant of the health care reform debate is changing; Democrats still argue the health care reform is the most ambitious social program implemented in the United States since Medicare was passed in the 1960s, while Republicans still say it has put the United States on the slippery slope to socialism and a destroyed health care system. After all, it is election year and Republican lawmakers up for reelection need to appease those voters who want Obamacare repealed without alienating their more moderate constituents. More importantly, the party’s leadership is aware the same arguments against the individual insurance mandate can no longer be made.

The full, so-called “known-on effects” the law will have on the economy and on the American health care system may never be precisely quantified. It has even been difficult for the administration and health care experts to determine how successfully Obamacare expanded insurance coverage, the reform’s main goal. Still, some attempts have been made to evaluate the impact of the Affordable Care Act.

A Monday report from the nonpartisan Congressional Budget Office contained an updated estimate on how the Affordable Care Act will impacted the United States budget and the health insurance industry. The exchange program intended to expand insurance coverage will cost the government $104 billion less over the next decade than originally projected, and in 2014 alone, the coverage provisions will cost $5 billion less than the $41 billion calculated earlier in the year. Plus, the CBO estimated that Medicare outlays will decrease by $98 million over ten years, compared with the February estimate, thanks to lower prescription drug and hospital insurance expenditures, while Medicaid spending would decrease by $29 billion.

The CBO’s downwardly revised estimate of the cost of the Affordable Care Act’s coverage provision impacted the United States deficit; compared with the February estimate, the report notes that he agency’s cumulative deficit forecast for fiscal years from 2015 through 2024 will decrease by $286 billion to $7.62 trillion, with reduced health cost estimates comprising a majority of that decrease.

In addition, Gallup has now confirmed that the country’s uninsurance rate is declining as a result of the health care reform. But the insurance rate among adults aged 18 and older is only falling in the states that chose to both expand Medicaid and set up their own online insurance exchanges. On average, in the twenty-one states and the District of Columbia that both created their own insurance exchanges (rather than defaulting to the federally-facilitated exchanges) and expanded Medicaid, the insurance rate fell from 16.1 percent in 2013 to 13.6 percent in the first quarter of the new year — a decline of 2.5 percent. By comparison, in the remaining states that took only one or neither of those actions, the uninsurance rate dropped from 18.7 percent to 17.9 percent, — a decrease of 0.8 percent.

“I think Democrats have the ability to steal the health care issue back from Republicans,” health care industry consultant Bob Laszewski explained to the Associated Press in a recent interview. “There is still time to tell the story of Obamacare to voters,” he said. It may be true that “Democratic candidates don’t want to be defined entirely by the health law,” political consultant David DiMartino added, “but now they can point to its successes to fend off the inevitable distortions.”

Distortions created by the Republican party could have been the unofficial theme of President Barack Obama’s Thursday press conference, which revealed that 8 million people have signed up for private insurance via Obamacare’s health insurance marketplaces. And, taken together, his comments suggested that Democrats running for office in Novembers should not avoid discussing the health care reform because there is a positive story to tell voters. When asked by by Politico’s Edward Isaac-Dovere whether he would advise members of his to campaign on the Affordable Care Act, Obama said: “I think Democrats should forcefully defend and be proud of the fact … we’re helping because of something we did.”

“This thing is working,” the president said of the Affordable Care Act. While he acknowledged the premiums will likely keep increasing, “as they have for decades,” Obama emphasized that since “the law took effect, healthcare spending has risen more slowly than at any time in the past 50 years.” He outlined how “real Medicare costs have nearly stopped growing” thanks to the reform law, the life of the Medicare trust fund has been extended by ten years, and the CBO has estimated that insurance premiums for plans purchased through the individual exchanges will be 15 percent lower than originally predicted. “Those savings add up to more money families can spend at businesses, more money the businesses can spend hiring new workers,” he said. He then proceeded to run through the litany of oft-repeated benefits of Obamacare, from the fact that no American with a pre-existing condition like asthma or cancer can be denied coverage to the fact that no woman can be charged more just for being a woman.

“I have said before this law won’t solve all of the problems in our healthcare system,” the president acknowledged. “We know we have more work to do. But we now know for a fact that repealing the Affordable Care Act would increase the deficit, raise premiums for millions of Americans, and take insurance away from millions more, which is why, as I said before, find it strange that the Republican position on this law is still stuck in the same place that it has always been,” Obama said.

He argued that even though many Americans may not agree that Obamacare was the correct way to address the problems with the United States health care system, the country can agree that time can be better spent pursuing fixes for the economy than launching additional appeal attempts. “The 50 or so votes Republicans have taken to repeal this law could have been 50 votes to create jobs by investing in things like infrastructure, or innovation, or 50 votes to make it years for middle class families to send their kids to college, or 50 votes to raise the minimum wage, or restore unemployment insurance that they let expire for folks working hard to find a new job,” he said. “The point is the repeal debate is and should be over. The Affordable Care Act is working, and the American people don’t want to spend the next two-and-half years refighting the settled political battles of the last five years.”

When asked whether the political climate was right for minor adjustments to be made to the law now that the administration’s enrollment target has been surpassed, Obama replied, yes. But he also noted that “but it will require a change in attitude on the part of the Republicans.” For Democrats, the challenge is to work with certain members of the Republican party who believe making the Affordable Care Act function better would be concession to the president, he argued. “And I recognize that their party has gone through, you know, the stages of grief, right? Anger and denial and all of that stuff, and we’re not at acceptance yet, but at some point my assumption is that there will be an interest to figure out how do we make this work in the best way possible.”

Laszewski also believes “the Democratic Party can become the party of fixing Obamacare.”

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