A tale of two narratives on Obamacare

Updated
 

Even by Washington standards, the disconnect between the left and right on health has been especially jarring this week. To hear Republicans tell it, the Affordable Care Act is unraveling before our very eyes, collapsing under its own weight, and desperately needs to be repealed.

Meanwhile, Democrats and their allies are practically taking a victory lap, as evidenced by President Obama’s event in the White House yesterday.

Take a look at the transcript of the president’s remarks and you’ll notice he has quite a bit to boast about, starting with the checks millions of families are receiving in the mail from their insurance companies. It’s part of “Obamacare” that technically called the medical loss ratio, but the idea isn’t as complicated as the name: under the law, insurers are required to spend 80% of your premiums on actual health benefits, rather than company overhead (marketing, lobbying, executive salaries, etc.). When an insurer spends less than 80% on care, the company is required to send you a check for the difference.

As the president asked at the event, “I’m curious – what do opponents of this law think the folks here today should do with the money they were reimbursed? Should they send it back to the insurance companies? Do they think that was a bad idea to make sure that insurance companies are being held accountable?”

They were rhetorical questions, though I wouldn’t mind hearing the answer from the congressional Republicans who keep voting over and over again to repeal the law.

But Obama went further, noting falling premiums and slowing costs. This line from his remarks also stood out for me: “In states that are working hard to make sure this law delivers for their people, what we’re seeing is that consumers are getting a hint of how much money they’re potentially going to save because of this law.”

In states that are working hard. In other words, the law is proving to be quite effective in those states where policymakers are actually trying to do the right thing. It was a subtle message to Republican policymakers in states trying to sabotage the law: all you’re doing is undermining the interests of your own constituents.

Looking at yesterday’s event in the larger context, however, we see Democrats continuing to go on the offensive on health care at a critical time.

Indeed, it’s not just the White House – Americans United for Change, a progressive activist group, launched this new ad in D.C. this week.

And while Republicans vow more pointless repeal votes, Jamelle Bouie makes the case that their desperation is coming from a position of weakness.

As the law comes online in the next five months, untold numbers of uninsured Americans will either receive benefits through Medicaid, or they’ll begin to enter the exchanges, receive subsidies, and purchase health insurance. In short order, the Affordable Care Act will have created a constituency for itself – the millions of voters who receive benefits as a result of the law. It will yield countless politicians – at all levels of government – who will want to capitalize on this constituency by working to implement it as best as possible. And this isn’t just true for blue states – you’ll see a similar dynamic in red states, where exchanges will also exist.

It’s Republicans who are caught in a bind. Soon, they’ll either have to accommodate the law in order to satisfy their constituents, or continue their quest for repeal, and in the process, further harm their political standing.

As for Obamacare’s implementation challenges, they are real and there’s an enormous amount of work for the administration and its allies to do. But as Jonathan Cohn explained yesterday in a very good piece, the recent developments surrounding the Affordable Care Act are “genuinely encouraging.”

Why? Because insurers’ bids “are coming in lower than most experts had predicted,” the overall price of Obamacare “is going to be even lower than predicted,” and insurers are making assumptions now based on expectations of success.

Affordable Care Act and Obamacare

A tale of two narratives on Obamacare

Updated