A woman holding a sign in support of the Affordable Care Act is seen as President Barack Obama's motorcade returns to his vacation compound from the gym at Marine Corps Base Hawaii on December 29, 2013 in Kaneohe Bay, Hawaii.
Kent Nishimura/AFP/Getty Images

The ACA on a winning streak

As a substantive matter, the nature of the debate over the Affordable Care Act has changed dramatically in just the past few weeks. On every metric that matters – enrollment data, rate of uninsured, systemic costs, premiums – there’s been quite a bit of news, and all of it’s heartening for those hoping to see the American system succeed.
But as the substance changes, the politics and broader impressions are changing with it. Democrats who were expected to avoid “Obamacare” at all costs as a campaign issue are starting to do the opposite. And Beltway media that talked up ACA peril is now conceding the system is “making a pretty impressive run.”
The headlines about the Affordable Care Act have turned positive lately, and they’re starting to pile up. The most dire predictions from the law’s critics simply haven’t panned out, and now Democrats are headed into another big health care fight – the confirmation of a new Health and Human Services secretary – with stronger real-world evidence than they’ve had before.
There’s important information we still don’t have about enrollment, and big risks loom on the horizon. Things could change. But right now, the tide seems to be turning in the White House’s favor.
Narratives feed on themselves, and there was a time when Obamacare just kept losing…. But over the past few weeks, the news has started to roll in the other direction…. Now it’s good news snowballing, and it’s critics who increasingly seem to have missed the mark with their warnings of inevitable collapse.
So much for the “death spiral.”
It’s against this backdrop that House Majority Whip Kevin McCarthy (R-Calif.) issued a brief report this morning, as part of the “House Obamacare Accountability Project.” (House Republicans have actually created a formal project with its own name for their initiative to root for ACA failure.) The 1,100-word piece intends to “debunk” the encouraging news of late, but McCarthy’s indictment doesn’t actually disprove anything. It asks some questions and repeats some old, bogus talking points, but for those who’ve followed the debate closely, it’s surprisingly pretty easy to debunk the House GOP’s attempted debunking.
With this in mind, it’s probably time to start thinking more about “Obamacare Derangement Syndrome.”
Back in October, Ezra Klein published a brutal piece blasting the “Obamacare disaster,” saying at the time that the system was a “failure.” At the time, conservatives decided they loved Ezra Klein.
Last week, however, he wrote that HHS Secretary Kathleen Sebelius’ resignation was deliberately timed to coincide with all of the Affordable Care Act’s successes. And it was at this point that the right suddenly decided they hate Ezra Klein.
Reading the over-the-top tirades about Ezra’s accurate assessment, it was hard not to notice that Republicans weren’t actually raising specific concerns. Rather, Ezra had said the ACA is working, and conservatives responded as if the very idea was ludicrous because, well, just because. Obamacare must be failing because it’s Obamacare, they said, as if the ACA name and failure were inextricably linked for eternity.
He followed up this week:
Republicans used to talk about Bush Derangement Syndrome…. Today, the right struggles with Obamacare Derangement Syndrome: the acute inability to see Obamacare as anything but a catastrophic failure that the American people will soon reject. For those suffering from ODS, all bad Obamacare news is good news, and all good Obamacare news is spin. In this world, delays of minor provisions in the law prove that the entire structure is collapsing, while surges of millions of people enrolling in insurance don’t prove anything at all.
ODS has kept Republicans from updating their mental model of how Obamacare is doing. The law’s disastrous rollout proved that it was doomed. The fact that it recovered beyond anyone’s expectations – literally, not a single analyst or policymaker I spoke to in December thought it credible that the exchanges would sign up 7 million by April, much less 7.5 million – hasn’t made much of an impression.
This may work for a while, but it’s not a sustainable approach to reality. If you’re basing your opinions on a health care system by closing your eyes, sticking your fingers in your ears, and yelling “la la la la,” you’re probably not well positioned for long-term success.