The Success of Obamacare and The President’s Legacy

May 7th, 2013

The Times explores how the Republicans will try, for the third election, to make Obamacare a pivotal issue (2010, 2012, and now 2014). Most of the article retreads some of the recent controversies over the law, but one bit in particular stuck out:

The stakes for the president are high. The ultimate success of the law, and in turn his domestic legacy, depends on how well the insurance marketplaces operate, and whether enough young Americans enroll for coverage.

Throughout the enactment of the ACA, the President continuously referred to his eponymous law as his “legacy.” As I note in Unprecedented, “Although President Obama is proud that historians will call the Affordable Care Act “Obamacare” and refers to it as his “legacy,” I think we should let history decide its fate.”

Due in large part to Republican recalcitrance, the implementation of Obamacare will be, in the words of Max Baucus and Harry Reid, a “trainwreck.” And this will only be the beginning of the difficulties and frustration with the law that has already increased premiums in most states, and, if studies from Oregon studies prove correct, will have only minimal impacts on public health despite staggering costs.

Of course, even assuming that the implementation is successful, as I document in Unprecedented, young, health adults–the very people that the ACA sought to add to the insurance pool–are increasingly unlikely to purchase insurance and may instead pay the penalty.

The White House already recognizes the difficulty, and importance of this demographic:

He will especially urge healthy young adults, those up to 35 years old, and minorities — groups in which he has “a lot of cachet,” Mr. Pfeiffer said — to sign up starting Oct. 1 for the new exchanges. Beginning Jan. 1, most Americans must have insurance or pay fines.

Without the participation of that generally healthy young population, insurance premiums for everyone else would increase — threatening support for a law already short of it.

This is going to be a mess. Obamacare may indeed become a “political millstone for Democrats in 2014” and beyond.