If Democrats are looking for a silver lining in 2014, it’s probably that the ObamaCare rollout was so disastrous, even modest improvements may seem terrific by comparison.
There are still back-end issues, to be sure, but the website has gotten better in recent weeks. And my guess is that — though there will be stories about the incredulous uninsured being turned away from doctor’s offices in the New Year — these sorts of problems won’t amount to the catastrophe that was once feared.
But larger, less obvious, problems still linger. Adverse selection (older and sicker people are more likely to sign up) could still cause all sorts of problems, not the least of which is the likelihood of rising premiums in 2015 (conveniently, the enrollment date was moved until after the midterm elections.) Rising premiums could ironically cause even fewer young and healthy people to sign up, exacerbating the problem, and possibly leading to the dreaded “death spiral” we heard so much about in 2013.
An even more immediate political problem is that the “if you like your plan/doctor you can keep it” canard — which strikes to the heart of President Obama’s very credibility — will continue to impact more and more people in the New Year.
For example, as small businesses renew their insurance throughout the year, some will inevitably decide to change or drop coverage. When that happens, the broken pledge will be back in the news.
But there’s more. About a third of people on Medicare receive benefits through Medicare Advantage — a program whose payments are substantially cut through ObamaCare. The cuts will likely be passed along to seniors in the form of benefit cuts and — you guessed it! — fewer choices concerning doctors.
(The fact that this is just now becoming a problem is an example of how the decision to stagger ObamaCare’s implementation — for short-term political gain — meant Obama would constantly have to contend with new fronts opening. The danger is of dying of a thousand cuts.)
Another challenge on the horizon is the employer mandate (yes, the Obama Administration unilaterally postponed it until next year, but employers will have to make the decision and begin informing employees about whether they will comply with the mandate or pay the penalty this year).
Presumably, some companies will decide it’s cheaper to pay the penalty and kick their employees into the exchanges. They might even be able to provide a pay raise and still save money by going this route.
Now, some conservatives will say this is a good thing, inasmuch as it disconnects insurance from employment. But the bottom line is that — for anyone who loses employer-based insurance due to the individual mandate — the notion that they can keep their insurance/doctor if they like it will be simply untrue. And, I suspect, many will resent it.
Even as some of the nagging superficial problems regarding ObamaCare are starting to dissipate, it’s clear there are a lot of fundamental problems that will continue to manifest throughout 2014 — and beyond. My guess is this spells big trouble for Democrats in 2014. The real question is whether or not it gets turned around in time for 2016.