The PJ Tatler

The GOP's Nightmare Obamacare Scenario

Byron York writing at the Examiner:

On the other hand, a lot of thoughtful conservatives are looking beyond Oct. 1 to Jan. 1, the day the law (except for the parts the president has unilaterally postponed) is scheduled to go fully into effect. On that day the government will begin subsidizing health insurance for millions of Americans. (A family of four with income as high as $88,000 will be eligible for subsidies.) When people begin receiving that entitlement, the dynamics of the Obamacare debate will change.

At that point, the Republican mantra of total repeal will become obsolete. The administration will mount a huge public relations campaign to highlight individuals who have received government assistance to help them afford, say, chemotherapy, or dialysis, or some other life-saving treatment. Will Republicans advocate cutting off the funds that help pay for such care?

The answer is no. Facing that reality, the GOP is likely to change its approach, arguing that those people should be helped while the rest of Obamacare is somehow dismantled.

The administration is fully aware of its advantage. Last week officials invited several prominent liberal bloggers to a special White House Obamacare briefing. From the reporting that resulted — one headline included the declaration “Implementing the Affordable Care Act is going to be a huge success” — administration officials are quite confident that, whatever problems arise, Obamacare will be solidly in place after the money starts flowing on Jan. 1.

“Neither Democrats nor Republicans liked to emphasize how much the Affordable Care Act debate was about redistribution rather than health care as such, but there’s a lot of money here,” wrote Slate’s Matthew Yglesias, who attended the briefing. “The law is structured to be financially beneficial to a large majority of people, and the infrastructure is in place to make that clear to a critical mass of them.”

Truth be told, many Republicans did note that redistribution is at the heart of Obamacare. But the fact is, the redistributing will begin Jan. 1. And whatever else goes wrong with Obamacare, look for the White House to apply whatever fixes it must to make sure the money keeps flowing.

There has never been an entitlement that, once implemented, has ever been repealed. This is the sad history that Republicans have to deal with. Once that cash starts to flow — Medicaid expansion too — a constituency for the law will form. Along with that constituency will come lobbyists, advocates, PACs — the whole rotten Washington infrastructure of influence all geared toward protecting the entitlement.

The Obamacare rollout on October 1 will probably not be a total disaster. People may already have been frightened away from the exchanges and may take a wait and see approach to signing up. By the time January 1, 2014 comes around, many of the bugs will have been eliminated. That won’t help those who will see their premiums skyrocket or lose the coverage with which they were perfectly satisfied:

None of this is to say Obamacare won’t face huge problems. The most obvious is that it will make things worse for more people than it helps. If that disparity is huge — that is, if on one side there are many millions of people paying more for coverage than they did previously, losing coverage they were satisfied with, and suffering through great uncertainty, while on the other side there are far fewer people receiving direct government subsidies — if that happens, then the political fight over Obamacare will intensify rather than fade. But even then, the subsidies are unlikely to go away.

Obamacare could face even bigger problems. The most serious is the so-called “death spiral,” which could occur if too few young, healthy people sign up for coverage, dramatically raising the cost of covering everyone else.

The massive PR campaign planned by the White House may yet convince the “young invincibles” to sign up. Somewhere at HHS, there’s a magic number of insureds who must sign up to make Obamacare viable and avoid that “death spiral.” Given the determined push by the White House, it is very possible they will reach that goal.

There is talk of the GOP shutting down the government in order to stop funding Obamacare. But it may be too late for that. Once the exchanges open, the momentum will be on Obama’s side and it will be very hard to stop.