It’s all about Obamacare in America

by Jonathan Todd

Beyond being the first African-American president, an achievement, obviously, secured on day one, the Affordable Care Act (ACA) or Obamacare is Barack Obama’s best, perhaps only, hope for a positive, domestic legacy. Opposition to it binds Republicans. While it’s almost 4 years since Obama signed it into law and as a result, as of 1 January 2014, 6 million Americans are receiving insurance that they otherwise wouldn’t, it remains the dominant issue in US politics.

Obama has improved the economy, repealed “don’t ask, don’t tell” and exited the US from unpopular wars, while avoiding others and killing Osama Bin Laden. Largely creditable but not governing prose to match 2008’s poetry, which perhaps was pregnant with disappointment.

Equally, it shouldn’t seem too much to expect more concrete steps to eradicate the causes of the 2008/09 crash, a less dysfunctional DC, and a Middle East strategy that doesn’t cede so much to the regimes of Iran and Syria – especially when coinciding with an intended pivot to the Pacific that is not preventing China and Japan edging toward World War III.

This underwhelming record and the impending inevitability of lame-duck status makes ACA, the most significant US healthcare reform since the 1960s, vital to Obama’s submission to history’s judgment. The pendulum is swinging against his party, however.

In 2014, the Republicans are likely to hold the House and with victory in either North Carolina or Louisiana will probably take the Senate. There is a growing audience for what they have to say. It’s not clear, though, that they have much to say. Except how awful ACA is.

Re-election as governor in a traditionally Democratic state makes Chris Christie the Republican’s presidential frontrunner. To be this candidate, he’ll need to win the support of a party that brings together social conservatives and economic liberals, as well as Wall Street and rural America.

A positive platform to galvanise this eclectic bunch is a tough ask. ACA will loom large in its negative campaigning. That Republicans find it easier to agree on what they oppose, rather than what they support, means their legislative tactics will continue to raise the stakes on ACA.

The GOP House might, say, vote to repeal Sections 1341 and 1342. If this became law, it would prevent Obama from ending his presidency bailing out insurers, having begun it bailing out bankers. As unpopular as bailouts are, such law is less likely while the Democrats hold the Senate, though they may cease to during 2014.

Which, from Obama’s perspective, increases the importance of Congressional Budget Office projections holding. They forecast that 40% of those enrolled in the new health insurance marketplaces will be young adults. The more this falls below this threshold, the more unbalanced these marketplaces are likely to be, increasing the risk of bailouts being sought and the vulnerability of the whole of ACA in the event of Sections 1341 and 1342 being repealed.

It’s a slight exaggeration to say ACA is the whole of American politics. Colorado seems to be being run by a cousin of Uncut’s Callum Anderson, as Steven Seagal considers a tilt at Arizona. American’s dozen largest cities are all run by Democrat mayors. In contrast, to only half of them being so 20 years ago. Urban and liberal America ever more complement one another. And John Kerry may surprise everyone by delivering a two-state solution between Israel and Palestine.

Little of this, however, will feature in the presidential race. ACA will.  The left chide its market based mechanisms. It’s similar to the Republican counter proposals to Hillary Clinton’s attempted 1990s healthcare reforms. But, as a 2016 presidential candidate, Clinton is unlikely to revisit these reforms. Instead, she’ll celebrate that ACA has established the principle that healthcare is a right, not a privilege, while seeking pragmatic means to contain its costs.

Building upon ACA with cost-containing measures may also be the stuff of a centrist Republican candidacy – particularly as the market based mechanisms that frustrate the left also mean that any Republican replacement of ACA would end up looking suspiciously like ACA. Whether a candidacy that sought to build upon ACA, given the tribal depth of Republican opposition to it, could secure their nomination is uncertain. The extent to which the holder of this nomination would be hobbled by commitment to repeal ACA would depend on its performance in the interim.

Which, restricted in his capacity to impose himself on Congress, is one domestic issue that the world’s supposedly most powerful man remains well placed to influence. The great persuader of 2008 needs to persuade sufficient young adults to participate in his new healthcare markets for them to remain viable. Otherwise he increases the risk of a Republican president committed to ending them. Even if such a president would be likely to be drawn back to similar market based approaches.

They wouldn’t be called Obamacare anymore, though. And Obama’s legacy would be commensurately diminished. While a recent CNN-ORC head-to-head presidential matchup put Christie two points ahead of Clinton, he may come to depend upon being succeeded by the woman that he defeated in 2008, as oppose to Christie.

Jonathan Todd is Deputy Editor of Labour Uncut


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6 Responses to “It’s all about Obamacare in America”

  1. Ex-labour says:

    Obama doesn’t give a damn about the UK so why should we care what happens to him?

    At the height of the BP oil spill I spoke to one of my American friends and said Obama was anti British, the response was “he’ll, he’s anti American”.

    Says it all really.

  2. swatantra says:

    Nonsense. Obama is neither anti-British nor anti-American; he’s a Democrat.
    Good luck to ACA! we need a balance between providing affordable care and some people exploiting free care services, leaving more pressure on those that actually need it.

  3. BenM says:

    Obamacare is working and the more it works the crazier the GOP is going to become.

    It’s a shame the initial rollout was botched.

    But the GOP relying on that botched status to last have been confounded by reality. Again.

    And the demographics are running away from the Republicans.

  4. Ex-labour says:

    @swatantra

    I take it you didn’t pay any attention to what Obama said during the BP spill. His bile was constantly directed at BP deliberately calling them British Petroleum when in fact it is not their name and they are more US now and he knows that.

  5. Robert says:

    Obamacare is probably not perfect but I cannot see it being totally repealed. On Obama himself, people had unrealistic expectations that were never going to be fulfilled but he is still the best President in my lifetime.

  6. We have got to let the states run their own health care systems. It is the better way to protect the public, as the public will have more direct input, and there is more accountability by virtue of size alone. We do not want the federal government accessing our health records as well as all our communications.

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