The Administration has snatched victory from the jaws of defeat and enrolled 7 million people (give or take a million who may not have paid their premiums) into health plans under the ACA, and more into Medicaid. The Affordable Care Act (ACA) isn’t as big a change as some of us would have liked, But in this moment of modest celebration let’s remember what some of the sensible old men said all along.
Sensible old men said reform couldn’t pass without bring in the Republicans. Sen. Baucus tried hard to do that, and it’s beyond clear that no Republican would have ever supported it–even a moderate like Snowe who was quitting. It passed anyway.
They said that we’d see massive rate shock. Instead plans tightened networks and rates were in general lower than they had been before.
They said that the web site debacle meant no-one would sign up and we’d go into an insurance death spiral. The web site launch was a cock up, but Medicaid expansion (where allowed) has more or less been OK, and the exchange web site(s) now more or less work(s)–outside Oregon & Maryland. By the way this backs my argument for having one Federal exchange, which you may remember was in the House bill before we ended up being forced to take the Senate version due to Ted Kennedy’s death.
One wise old man (Robert Laszewski) was still saying that the exchanges would be financial disaster for insurers the very week Wellpoint raised earnings expectations because they had more enrollees than expected.
Let’s also remember that because of the politics of the nation, the ACA is a ridiculous hodge-podge of a law requiring–you’ll recall:
a) an opt-in to what’s basically a social insurance program (hey, let’s opt-in to fire protection while we’re at it!)
b) arbitrary tax (and now subsidy) distinctions between those who get insurance via an employer and those who don’t, and
c) arbitrary access to insurance (well, Medicaid) for the poor depending on their income and which side of a randomly drawn line they live.
If this was a sensible country no one would have designed either the system we had before or the ACA–which is itself very trivial reform–as the solution to fix it. But if this was a sensible country the Senate would have been abolished by 1935 (or sooner).
But given the hand they have, I’m not convinced the Administration and those rolling out the bill have done that bad a job. Don’t forget that the previous Administration’s crowning achievement (also coming from sensible old men) was the restoration of peace & democracy in Iraq. The ACA’s doing way better than that!
And the sensible old man’s alternative of waiting for a grand coalition would have meant that we did nothing. And frankly anything’s better than that.