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Analysis: Obamacare Can't Fail

karen roach/Shutterstock.com

The standard of success for the Affordable Care Act keeps getting weaker.

Whether in enrollment numbers, federal savings, or the workings of its website, the White House has repeatedly lowered the bar for the law when it has missed expectations, replacing initial standards with ones that are lower, squishier, or nonexistent.

Just a few months ago, Health and Human Services Secretary Kathleen Sebelius said success would entail covering 7 million people this year. Now, the White House has disowned that standard for enrollment—and it hasn't come up with a new one.

President Obama touted HealthCare.gov, the main portal to shop for coverage, as the "Amazon" or "Expedia" of health insurance. Now the administration is calling it a win for the site to be "functional for the vast majority of users," and even that standard has been watered down since its debut.

And when the law passed, it was expected to reduce the federal deficit by about $210 billion over a decade. Now the projected savings are about half that, largely because one big program proved unworkable.

At this point, the White House's definition of success seems to basically boil down to "not failure"—a standard that falls far short for a law that used up so much political capital and was sold with such grand promises.

At this point, when asked to define success for 2014, White House officials often answer by noting that the worst-case scenario for the health care law is unlikely to happen. But that "non-failure" standard falls far short of the high expectations Democrats once had for the law, and of the promises they made to sell it.

"They are masters at moving the goalposts, and they have done that a lot. They'll move the goalposts again," said Douglas Holtz-Eakin, a conservative economist and former Congressional Budget Office director who now leads the American Action Forum.

Most recently, the White House has been looking to distance itself from the expectation that it would enroll about 7 million people in the first year of Obamacare coverage. The estimate came from the CBO, and the administration described it in pre-launch memos as a "target" for 2014. "I think success looks like at least 7 million people having signed up by the end of March 2014," Sebelius said in September.

But HHS' ability to hit that mark is in question because of the rocky HealthCare.gov rollout, and the administration now says 7 million wasn't its goal, or even its estimate.

"That was CBO's projection, not ours. I'm not aware that we put a numerical projection on what we hope to see by March 31st," White House spokesman Jay Carney said last week.

(When the White House says the law will ultimately cover 25 million people, or that it will reduce the deficit—two points it is still fond of making—those predictions are also based on CBO estimates.)

Regardless of the White House's definition, policy experts—even conservatives—agree that Obamacare will survive 2014 even if it doesn't hit 7 million people.

The total number of people enrolled, across all 50 states, is a political metric as much as a policy one. Each state is its own risk pool, and each insurer within each state will base its premiums on the people who sign up for its plans. So, although a critical mass of people need to sign up in each state, the law's survival likely depends more on the mix of healthy versus old and sick enrollees in each state.

The law also has enough built-in checks, balances, and safety nets that the worst-case scenario—a "death spiral" in which rising premiums beget fewer customers, which begets even higher premiums, and so on—seems highly unlikely.

And Democrats aren't alone is distorting the law's record of success or failure. Republicans have been calling the law a failure since well before any of its provisions took effect, including blaming it for health care realities that existed long before Obamacare was born.

Democrats knew Republicans would call the health care law and the HealthCare.gov launch a disaster no matter what happened, and the GOP's doomsday predictions got Democrats off the hook from setting any expectations of their own—and Democrats have taken full advantage of the lowered expectations.

But that doesn't erase the high bar they set in 2010, when Obama and congressional Democrats put their political futures on the line to get health care passed. Obama said in a 2010 speech about health care that "we can do great things, and that here and now we will meet history's test."

The point of passing the Affordable Care Act was to cover some 30 million uninsured Americans, and progress toward that over-arching goal will be measured by how many people actually get covered each year.

But past that, the White House won't get into specifics. Asked for a 2014 enrollment goal, a White House official said the goal was to have a "robust insurance market with a good mix of people" and to enroll "as many people as possible."

(Image via karen roach/Shutterstock.com)

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