As readers of these posts will recall, I'm not the biggest fan of the Affordable Care Act. My view is that the legislative compromises needed to get the ACA through Congress made it an unwieldy mess; that the bungled roll-out was a logical outcome of its Rube Goldberg structure. The claims of the president's loyal supporters that all is being fixed and that the ACA will still be a net political winner by November sound like so much whistling past the graveyard.
Nonetheless, the damage done by the ACA rubs off, not only on President Obama, but on the Democrats' chances of holding the Senate and on American progressivism as a whole. If Republicans take both Houses of Congress, Obama in his final two years will be the lamest of lame ducks. The rarely wrong Nate Silver projects a Republican takeover of the Senate this November.
With control of Congress, Republicans could well destroy the ACA by blocking its funding. And then it's anyone's guess which party takes the fall for even worse general legislative gridlock going into the 2016 presidential election.
So as a critic, but in the spirit of we-all-sink-or-swim-together, here are some thoughts about how to turn Obamacare from lead weight into a political lifeboat for this November. Though millions of Americans have had an unfortunate encounter with the ACA, either cursing out Healthcare.gov in frustration or facing premium increases or blaming policy cancellations rightly or wrongly on Obamacare, millions of others have benefited by getting affordable insurance for the first time.
There is one other relevant political category -- younger Americans who have not yet signed up for insurance because of the perverse incentives of the ACA's ban on denials for pre-existing medical conditions. The fine for not getting insured is so low -- from $95 to more than $500 depending on income -- that many economically stressed younger workers have rationally concluded that it's more cost-effective to just wait until they get sick and then get insurance.
That behavior has made the ACA less financially stable and reduced the coverage rate.
However, it may yet be possible to turn this lemon into political lemonade. Here is the speech President Obama should give--again and again with slight variations--between now and November.
"My Fellow Americans,
As you have surely heard, my Republican colleagues have pledged to destroy the Affordable Care Act if they win control of Congress in this November's election.
I will do everything I can to defend health reform, but two large groups of Americans should be aware of the risks that the Republicans mean what they say.
The first is youngpeople. The ACA guarantees that you can choose to stay on your parents' insurance until you turn 26, whether the insurance industry likes that or not. If the ACA goes down, you will be on your own.
Secondly, the ACA guarantees that nobody can be denied insurance because of a pre-existing condition. If the Republicans are successful, that provision could be scrapped, too.
So if you are you are young and healthy, and have been hesitating about getting insurance because you can always get it later should you become seriously ill, you might want to reconsider and get coverage now. If the Republicans take control of Congress in November, that guarantee just might not be there.
What's more, if the ACA goes down, so does the ban on exclusions for pre-existing conditions. That could well be applied to renewals of existing policies.
We had to fight to get these provisions into the ACA, in order to protect tens of millions of Americans. So you should buy insurance while you can.
And in order to make sure that your right to get insurance at affordable rates is never taken away, you should carefully consider who you vote for.
You may want to strangle the people who designed the website Healthcare.gov, but do you really want to kill the ACA?
I'm as frustrated as you are with the glitches in getting this program going. They are being fixed. But those frustrations are no reason to toss away protections that cover people at risk of getting sick and of not getting good medical care.
So please get insurance while you can, and please think twice about voting for those who would take it away."
This strategy is known as nationalizing a mid-term election. If Republicans want to make a promise to repeal or de-fund the ACA the centerpiece of this November's campaign, let's have that fight and educate Americans on just what repeal would mean. The ACA might even turn into a political winner -- or at least not the big loser that it now looks to be.
Economists have a nice concept known as "endowment effects." In plain English, that means people hate to give up what they have. The Republicans have turned that psychology against President Obama, because the ACA requires some really lousy insurance policies to be swapped for better ones that are occasionally more costly.
But by November, Obama could turn the psychology of endowment effects back against the Republicans. Do Americans really want to give up their right to get insurance despite being sick?
Is the conciliatory Barack Obama willing to be that partisan? His presidency and his greatest legacy could well depend on it.
Robert Kuttner's new book is Debtors' Prison: The Politics of Austerity Versus Possibility. He is co-editor of The American Prospect and a senior Fellow at Demos, and teaches at Brandeis University's Heller School.
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