What’s the big news of the week? The death of Paul Walker. The big news other than him dying? Healthcare.gov being repaired well enough that it works over 90% of the time and enrollment in the exchanges skyrocketing. For the moment, things seem to be working out.
However, there’s still some more problems that could occur between now and when the Affordable Care Act is fully implemented in March. The website could just be the tip of the iceberg. For example, there is a possibility that not enough young people will sign up. Then again, the exchanges have worked more or less just fine in states running exchanges. So maybe the Obama administration was merely unprepared but has now been awakened enough to make the necessary arrangements.
One thing is certain: this isn’t getting repealed. Jonathan Chait does a pretty good job of explaining why the Republican hope that the ACA will be repealed by veto override is likely a fantasy. Which means that it’s safe for some time. Perhaps, forevermore, as people will not like essentially being told that they have to give up health insurance. Particularly those with preexisting conditions that allow insurers to deny them coverage.
Chait also notes that with the ACA pretty much locked in, this entire conversation is about midterm elections. I concur. So let’s talk about midterm elections. Gallup has Obama at 41% approval today, so a Republican blowout? Not if this works out. If you find that hard to believe, consider how we went from a Republican tornado in 2010 to a fair margin of victory for Obama in 2012. A somewhat more promising economy, Republicans killing their brand with brinkmanship, and women flocking to Obama because of the right’s hostility to birth control made all the difference. Much further back, Ronald Reagan’s three Gallup numbers in January 1983 were 37%, 37%, and 35% in the face of double-digit unemployment. But as job creation revved up, he went well above the big 5-0 by year’s end.
So I give you the ways health care can affect 2014:
A meltdown followed by a Republican landslide. Basically, this is where the changes to the system become impossible to process. Result? Chaos ensues and the Republicans gain 6-10 Senate seats and 20-45 House seats.
This is the only scenario in which repeal of the ACA becomes a realistic possibility. Even if that doesn’t work, Republicans should be able to get some pet project (cutting food stamps and school lunches by a third springs to mind) over Obama’s veto.
Fixes come too late to save the Democrats. People seem to start deciding who to vote for in the summer. That’s why Obama’s miserable first debate performance against Romney last year wasn’t offset by a fantastic jobs report days later. If final implementation of the ACA is screwed up, the Obama administration has until May to fix it before it faces backlash in November.
Still, the fixes will halt Republican momentum by the time the newly Republican controlled Senate is sworn in. Which means that the only difference between this and the meltdown scenario is that Obama will actually have to start vetoing bills.
Moderate botching. The ACA is implemented badly but not disastrously so. That means that the Dems suffer a slightly worse then average midterm defeat for the President’s party. Since the Republicans need at least six seats to win the Senate, this might not be enough.
Easy does it. With enrollment way up, it’s probably going to take a lot of screw-ups to shut down the program. So a mixture of incompetence and success stories could be coming. Electorally speaking, this is a wash.
Republicans drop the ball. I don’t think enough mind is paid to the fact that the Republican party has a tendency to screw up opportunities. Remember the government shutdown and how it briefly gave rise to the idea of Dems winning back the House? Republicans have at least one more chance to shut down the government. That could very well yield all the goodwill they’ve gotten from the administration’s comedy of errors.
Plus, their litmus tests tend to lead to unelectable kooks getting nominated. If the recent past is any guide, they will throw multiple races. That could easily be the difference between a Democratic or Republican Senate.
Moderate success. The health care bill works, but not magnificently so. The result is a status quo election in which the balance of power changes little in either direction.
Democratic victory. Finally, if the worst turns out to be behind us, the rollout will not be a problem for Democrats. I still wouldn’t expect them to win big unless the Republicans foolishly shut down the government again, though.