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ACA Revisionism
Obamacare Invictus?

The Affordable Care Act is working, and Democrats can win midterm elections by running on it. That’s the line President Obama is taking—and the media have picked it up with gusto and not a little relief. The White House triumphantly reports that eight million people have signed up for insurance on the federal exchange, almost one million more than the number announced two weeks ago and also more than the Congressional Budget Office’s revised estimate predicted. President Obama then instructed Democrats to defend Obamacare and run on it in the midterms. Obamacare’s supporters in the media have decided that the debate is over.

But Democrats can count the 8 million enrollment figure as a decisive “victory” only by dramatically shifting the goalposts for the law, as Ross Douthat points out in a must-read column. Douthat concedes that the law isn’t in immediate danger of collapsing, as once seemed at least somewhat possible. In that limited sense the ACA is working, but the law’s supporters have promised so much more than that:

 In the summer of 2012, after the Supreme Court decision freeing up states to reject the Medicaid expansion, the C.B.O. projected that 14 million Americans would get coverage under Obamacare in the first year, and 33 million by 2022. This February, after the botched rollout, the projections were 13 million in 2014, 27 million in the long run. The latest estimate, out this month, drops the 2014 projection down to 12 million, and the long-term number to 26 million. Meanwhile, the question of how many previously-uninsured people have gained insurance as of right now is, as this Vox explainer suggests, quite difficult to answer […]

Before we entered into the agony of the botched roll-out, the law’s supporters were eagerly citing the persistently low rate of health care inflation as a sign that Obamacare was already working as designed, already having a beneficial effect. But as Vox’s Sarah Kliff reported yesterday, the latest inflation numbers cast some doubt on that hopeful hypothesis, with federal data indicating “that health care spending is now growing just as quickly as it was prior to the recession.”

Read the whole thing. Douthat shows that on the ACA’s own terms and according to several different metrics, the law is not anything close to a success—at least not yet. But this qualification of the ACA’s victory may not have an impact on the political fight. Judging by the recent media chatter, Obamacare’s defenders may well get away with defining victory down. And the GOP should note that its coverage of Obamacare’s every little flaw makes any minor success look like a triumph. Even if the line “eight million sign-ups means victory” doesn’t hold up in the long term, what we are seeing here is a textbook example of political revisionism.

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  • Nick Bidler

    If only the U.S. could negotiate prices like assorted European countries.

    But then, a monopsony (I think that’s right) is just as good as a monopoly when you’re the one that isn’t on the recieving end.

    • Andrew Allison

      Not quite. In a monopoly, the seller sets the price; in a monopsony (in your example, single-payer insurance), the buyer sets the price. I emphasize that in the case of single-payer healthcare, the recipient of the services is not the buyer, but the recipient of services purchased by the state. The situation in the private insurance market is different in that individuals buy insurance from one of many sellers who individually negotiate reimbursement rates with individual service providers. Hence the lack of transparency in pricing.

  • Andrew Allison

    The GOP must be hoping that the Democrats take Obama’s advice. By the time the mid-terms roll around, we’ll know both how many people actually enrolled, i.e., paid a premium, and what next year’s rates are going to be. We may even what the impact of the employer mandate is going to be. As to, “. . . any minor success look like a triumph”, I guess we’ll find out if and when there is one, as opposed to wishful thinking.

  • Breif2

    The soft bigotry of low expectations alights on Obamacare? 🙂

    “Obamacare Invictus?”

    If so, vae victis.

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