It might work. It just might work. Obamacare, I mean.
I seek to turn back on her smug self what that woman on television declared incessantly and sotto voce — that Obamacare “doesn’t work; it just doesn’t work.”
I refer to the political commercial that the woman said wasn’t a political commercial. It was paid for by a Koch brothers outfit to try to damage U.S. Sen. Mark Pryor and elect Koch disciple Tom Cotton to the U.S. Senate.
It had the broader aim of a substantial dismantling of government in favor of a corporate-run country.
As one who was concerned that limited enrollment and scant youth participation could wreak actuarial disaster for second-year premiums to be unveiled in October, and, in turn, cause Obamacare to collapse under its own weight, I wondered if the woman might not be right.
She still might be. But not necessarily. In fact, probably not now. Inertia and inevitability— these have reared their heads, and they are powerful forces.
The soft deadline of Monday night for individual-policy enrollment through the Affordable Care Act’s health insurance exchanges passed with an estimated 7 million either signed up or in the process of doing so. That would match the estimate of the Congressional Budget Office, which would serve the perception that, after all its trouble, Obamacare is on target.
While only an estimated 27 percent of enrollees are younger than 40 at last estimate, and while that needs to be 40 percent to give the pool sufficient premium income from healthy people not making claims, the latest word is that insurance companies thought of that already and built protections into first-year rates.
That is to say consumer rates might not explode so much in the second year.
Then young people who declined to participate this year would pay an income-tax penalty next year. That would lead them to the logical economic decision to enroll in the second go-round. Tax penalties double the second year.
Actuarial soundness would improve with every such second-year enrollment.
It wouldn’t matter that Republicans had taken over the U.S. Senate in November. They surely won’t have enough votes next year to override a presidential veto. And Barack Obama would still be president, an office good for something even in its last year.
Meantime, back in Arkansas, even a new Republican governor, Asa Hutchinson, would realize the advantages to the state budget of the private-option form of Medicaid expansion. And even Republican legislative majorities otherwise beholden to Koch money would be loath to throw a quarter-million people off health insurance.
The Arkansas success with the private-option would lead other anti-Obamacare states to embrace it or some version in order to take the federal Medicaid expansion money.
And all of would bring even more people into the exchanges and help keep premiums reasonable.
Then, in 2016, Hillary Clinton would get elected president after promising to preserve and improve the Affordable Care Act.
She would have been helped to election in part by the Obama administration’s postponing yet again the forced cancellation of cheaper substandard policies in effect at the time of Obamacare’s implementation.
A phrase comes to mind: too big to fail.
In time, Obamacare would endure the same narrative as Social Security and Medicare — the narrative of a Democratic social program that Republicans opposed desperately and warned would never work and tried and failed to kill.
It’s a plausible scenario, more plausible than it seemed last fall amid online glitches and cancellation notices; more plausible than it seemed in early February as the private option’s renewal appeared to be on life-support in Arkansas.
P.S. — The best remaining Republican hope for killing Obamacare rests in the place all best hopes for killing laws resides — the courts.
There is a mildly ominous lawsuit out there that says the ACA, owing only to sloppy drafting, allows federal subsidies for premiums only in state exchanges, and that policies bought on federal exchanges in states that set up no exchanges are not eligible for the vital subsidies.
It’s a bill-writing error. But voiding subsidies for millions of Americans would effectively destroy Obamacare, unless all states set up exchanges, which all states wouldn’t.
One thing Republicans have — and will continue to have — is enough votes to keep a technical error from being corrected.
John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.