States implementing ‘ObamaCare’ in good faith are seeing good results

Posted by AzBlueMeanie:

The Tea-Publican strategy for 2014 is to once again run against the Affordable Care Act (aka "ObamaCare"), focusing on every little problem, real or imagined, with the implementation of the program. Of course there are going to be problems with implementation, but rather than make adjustments to fix those problems, the Tea-Publican ideological knee-jerk reaction is to yell "kill it!"

Imagine how different the course of human history would have been without trial and error eventually leading to success and the advancement of the human race. If these people had been in charge, all modern scientific and technological advancements would never have occurred because damn near every one of them was a failure at first.

"ObamaCare" was set up to allow the 50 states to experiment and to learn what works best to establish best practices. AS FDR famously said of his New Deal programs, " It is common sense to take a method and try it: If it fails, admit it frankly and try another. But above all, try something."

For all the nit-picking by Tea-Publicans over the implementation of "ObamaCare," things are actually going quite well in states that are making a good faith effort to implement the program. Matthew Iglesias writes at Slate, Obamacare Rollout Is Going to Be Like a Train Getting You to Your Destination in a Timely Manner:

You heard it here first from me in April,
but I want to reiterate that over the next 18 months you're going to
read a lot of stories about problems with Affordable Care Act
implementations. Many of those stories are going to be accurate. But
fundamentally Affordable Care Act implementation is going to work out
great, and people are going to love it.

The latest evidence comes to us today from California, America's largest
state and one of the states that's tried the hardest to actually
implement Obamacare. As Sarah Kliff explains, their exchanges are
getting set up, and it looks like premiums for "silver" and "bronze"
plans are both going to be lower than was previously expected [California Obamacare premiums: No ‘rate shock’ here].

Far from a "train wreck," in other words, the biggest single set of
clients for the program is getting something like a nice, smooth
high-speed train ride. There was also good news from Oregon recently,
where insurers that had initially come in with high premium bids are now
asking to resubmit with cheaper offerings in the face of competition [Oregon may be the White House’s favorite health exchange]. And the Affordable Care Act's goal of slowing the growth in aggregate health expenditures is also coming true.

Now of course not every state is going to have as happy an experience as California and Oregon.

There are huge swathes of the country where public officials have
been deliberately refusing to try to make the new law work well, and
congressional Republicans are also doing their best to try to stymie
. Those efforts will succeed. Residents of California,
Oregon, Maryland, Massachusetts, New York, and other eager implementers
will see much larger gains from the new law than residents of Texas,
Florida, and Alabama. And since a very large share of uninsured
Americans live in those red states, this will be a real tragedy for the
country. But even in those places, people are going to end up better off
than they were pre-Obamacare, and the basic logic of politics is that
over time state officials in most places should put some effort into
trying to make things work.

You have to remember a few basic facts about ACA implementation coverage over the next 18 months. One is that the media has a large negativity bias.
The other is that the aspirations of the law are quite high, and the
status quo is quite bad. That means any time the situation improves but
doesn't improve as much as the Obama administration wanted things to
improve, that will tend to be covered as "bad news for Obamacare." That
tendency will be re-enforced because Republicans will be eager to
trumpet Obamacare's shortcomings (to make Obama look bad), and advocates
for the poor will also be eager to trumpet Obamacare's shortcomings (to
build pressure for improvement). So you'll hear lots of completely
accurate stories about things not working quite as well as proponents
had hoped. Just recall that this is always how things go.

Ezra Klein explained at the Wonkbook:
Some very good news for Obamacare

California is a particularly important test for Obamacare. It’s
not just the largest state in the nation. It’s also one of the
states most committed to implementing Obamacare effectively. Under
Gov. Arnold Schwarzenegger — remember how that really happened? —
California was the first state to begin building its insurance
exchanges. The state’s outreach efforts are unparalleled. Its
insurance regulators are working hard to bring in good plans and make
sure they’re playing fair. If California can’t make the law work,
perhaps no one can. But if California can make the law work, it shows
that others can, too.

* * *

The way this competition can drive down rates is already evident
in Oregon
. There, one insurer came in with monthly premium costs in
the $169 range, while other insurers asked to charge more than $400.
But then, seeing  what their competitors were charging, two
insurers came back to the state’s regulators and asked
if they could refile at lower rates. Otherwise, they wouldn’t be
competitive in the exchange. The Obama administration was ecstatic to
see this: It’s exactly what they’re hoping will happen across the

Of course, California and Oregon are managing Obamacare
particularly well. But the state-by-state nature of the Affordable
Care Act creates really unusual political dynamics around how the law
is perceived in its first year.

Imagine it’s the end of 2014. California now boasts a working,
near-universal health-care system. Nothing perfect, but clearly a
success after the first year of implementation. Texas, meanwhile, is
a bit of a mess. They didn’t allow the Medicaid expansion so the
state’s poorest residents got nothing. They didn’t help with the
exchanges, or the outreach, so there aren’t many choices, and
premiums aren’t as low one might hope.

Viewed in isolation, Texas’s problems would be deadly for the
law. But viewed next to California, they might mainly be a problem
for the political class in Texas, which has failed to implement a
clearly workable law

Paul Krugman also notes this political dynamic. Obamacare Will Be A Debacle — For Republicans:

[T]he preliminary numbers for CA are in
— and they’re looking very good, with costs coming in below
expectations. At this point, it looks as if this thing is indeed going
to work.

And think about the political dynamics. Because the Supreme Court
decided to let states opt out of the Medicaid expansion, some states —
notably Texas — will have a pretty dysfunctional version of Obamacare in
2014, although even those systems will provide significant benefits to
many people. Still, the whole political calculus was supposed to be that
Republicans in red states could point to the horrors of Obamacare and
ride them to political victory. Instead, it looks as if we’re going to
see blue-state residents reaping the benefits of a functional health
care system, while red-state residents are denied many of those
benefits, for what looks like no better reason than mean-spirited spite —
because what’s going on is, indeed, mean-spirited spite

Predictions that Obamacare will be a big political issue are probably right — but not in the way gleeful conservatives imagined.

There may be a political backlash against those Red State Tea-Publicans actively seeking to undermine implementation of "ObamaCare" out of mean-spirited spite. According to an analysis from the Los Angeles Times, the states that have the greatest need to expand Medicaid also have Republican leaders who are refusing to participate. The New
York Times
reminded readers on Friday that Republican governors and
legislators are rejecting the ACA's expansion of Medicaid that could
bring health insurance to millions more of their residents. More than half of all people without health insurance live in states that are not planning to expand Medicaid. That is going to be a motivated bloc of voters.

If the only thing standing in the way of affordable health care coverage are ideological extremist Tea-Publicans, the voting public is going to toss them out on their rears.

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