Finally, it’s put-up or shut-up time for health reform

I’ve been on the road, reading various depressing polemics on potential “rate shock” facing young adults who are now uninsured or buying coverage on the non-group market. If the typical newspaper reader understood that less than 14% of adults age 21-27 in this group would actually face the full unsubsidized cost of coverage in the new exchanges, we could waste less of our time on an absurdly-framed debate. I was all set to write yet another column by a liberal policy-wonk excoriating Avik Roy for his columns trying to establish that a relatively cherry-picked subgroup of healthy, relatively-affluent young adults will get hammered by health reform.

Then I just stopped.

We’re just past the point of partisan thrust and parry. Young adults will explore their options. Either they will have a positive experience with the new health insurance exchanges, or they won’t. Fifty-year-olds and 62-year-olds with diabetes will do the same. On the whole, I believe people will have positive experiences. Premiums on the new exchanges are reasonable, coming in below CBO expectations, and certainly below critics’ worst predictions.

I suspect  the worst backlash won’t actually come from uninsured or under-insured people who actually buy coverage on the new exchanges. Backlash will come from people with pretty crummy jobs who hear that their hours are cut back. Backlash will come from people with limited employer-based coverage who face higher premiums or encounter other changes such as disliked wellness provisions. Some will look across the fence at decent plans on the new exchanges, only to discover that they can’t receive subsidies if they spurn their employer’s coverage.

Thousands of employers will blame “ObamaCare” for whatever unpopular moves they impose their workers. It’s the obvious play. In many cases, this blame will be mostly or entirely misplaced. Other times, the blame will be justified, reflecting glitches or unintended consequences of the new law. Either way, many workers will believe what their employers tell them. Millions of workers with relatively modest incomes will see their lives getting a little worse when they were hoping that health reform would make their lives a little better.  Other people—I suspect many more—will see their lives getting a little or a lot better. Some of the most deserving people will seek benefits and medical care–only to  discover that no help is forthcoming because their states rejected Medicaid expansion. Republicans had better hope that this is a disorganized and politically marginal group.

At long last, we’re nearing put-up or shut-up time for the new law. ACA’s political fortunes will rest on whether it tangibly improves peoples’ lives. If it does that, the politics will take care of itself. If it doesn’t, Republicans won’t need Avik’s columns or anyone else’s to knock it down.


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