The shifting ACA narrative (sing along, you know the words) claims Obamacare is...

• a botched website
• DOA 
• not reaching young people
• not getting premiums paid 
• only having a small impact
• not reaching millions of people
• not reaching that many millions of people
• not reaching 20 million people

When your argument is about massiveness of scale, just six months in, it may be time to change the subject. Hey, look at those kids crossing the border!

If the Hagan campaign won't do it, outside funders need to start running ads right now that discuss the success of this law -- in numbers, and in human terms -- and the impact of Tillis-led Medicaid stonewalling. 

Comments

[John]

Ed with all due respect we won't know the full story on the ACA until the employer mandate is enacted in 2015. If you recall, it was supposed to be enacted this year. Mr. Obama decided to delay it for a year. And he did so without a vote in Congress. It was one of many delays Mr. Obama arbitrarily enacted.

I would say the most obvious reason for the delay of the employer mandate to next year was because the Obama administration did not want to see what "unintended consequences" (and they are always "unintended," heh heh) might occur during a mid-term election year.

Still a bit early for a victory lap, don't you think?

[Andrew Brod]

Economists don't see the employer mandate as a big deal. They don't care for it, as a rule, but that doesn't mean it's destructive. The mandate is a penalty paid by employers for not providing health insurance, but it only hits companies with 50 or more employees. More than 95% of all such businesses already provide health benefits. So its impact when implemented next year isn't likely to be huge, and that means it's unlikely to be a game-changer.

Because employer decisions to offer health insurance are largely unaffected by the penalty, the employer mandate is primarily a tax on large businesses that don't provide insurance. Sure, the mandate will change some behavior: there will be a small uptick in the number of large employers providing insurance. But its main effect will be to generate funding for other aspects of the ACA.

As a (mostly) tax, the employer mandate could have some disemployment effects (i.e. people might get laid off or not hired in the first place), but it doesn't affect enough firms for that effect to be big. Again, not a game-changer.

[Andrew Brod]

As for "victory laps," this appears to be a projection and a recurring theme of yours. But the good news for Obamacare keeps rolling in, and it'd be weird to pretend otherwise. Or to claim that acknowledging it is the same as taking a victory lap.

[Spag]

The very generous definitional pool from where the "20 million" figure is arrived and the admitted inability to account for those who were previously uninsured aside, you make the mistake of projecting your policy preference on to the general electorate, blind to the countervailing considerations.

The number of people in NC who may have acquired insurance because of Obamacare has to be weighed against the number of people in NC who did not acquire insurance because of Obamacare and believe that it is detrimental to their own interests or in fact has been detrimental to their own interest. Then you have to consider the number of people who acquired insurance because of Obamacare not by choice, but out of fear of the mandate.

I have to believe that the Hagan people know that many people will not be impressed by the number of Obamacare enrollees because they believe that it has come at a personal cost. They also have to account for the probability that those who did acquire health care because of Obamacare will actually vote and further take into consideration the number of those people who acquired insurance willingly. Simply put, if adding say 300,000 to the rolls of the insured results in pissing off 1,000,000 people, then it is not a winning number to run on. While it may be a feel good notion to run on the number of newly insured, it may be a politically losing position if you don't take into account the number of people who don't feel that it was worth the cost to them personally.

The calculation involves the number of people who:

Support Obamacare because now they have insurance
Support Obamacare because it resulted in other people having insurance
Oppose Obamacare because they were forced to get insurance
Oppose Obamacare because it has resulted in a personal detriment
Oppose Obamacare because they have a philosophical/political/economic objection to it

Of those groups, the Hagan campaign can only hope to pick off a few new votes from the second group because the majority are already in her camp, and those from the small first group that are actually likely to vote. She does this at the risk of further agitating the latter three groups. It may be her only play because the issue is going to be the centerpiece of this election, but to advertise it as an unapologetic victory dance is likely to paint her as out of touch with the majority of voters.

Your hope seems to be that she can alter the unfavorable poll numbers of Obamacare itself by touting its alleged success. But from a campaign strategy standpoint, that seems like a horrible idea. You can't accomplish that with ads or speeches. It has to happen organically. You can tell people what you want to do, but you can't tell them how they should feel about it. In this case, how people feel about it is beyond her control. This issue benefits her only if public opinion shifts as a result of individual experiences. Otherwise she is only preaching to the choir and right now the choir is on the losing side of this issue.

[Andrew Brod]

I doubt groups 3-5 are as big as you think. Not everyone who's "forced to buy insurance" will vote against Hagan, and the rich young people who didn't qualify for subsidies probably wouldn't have voted for her anyway. There may be people who believe they've been harmed by Obamacare, but steady drumbeat of good news about Obamacare suggests that the number actually hurt isn't big.

I can't imagine the 5th group being swayed by further pro-ACA messaging by Hagan, as the vast majority of them have already decided not to vote for her. Besides, if there's a group 5, there should also be a group 6: those who support Obamacare for philosophical/etc. reasons.

All in all, I don't think you've laid out a clear case that Hagan shouldn't promote ACA successes in the remaining months of this campaign. Besides, if it's such a bad idea for her, why would you spend so much time trying to argue that she not do it? Stop, Kay Hagan! Don't do something that I, a Republican, believe will increase the chances of a Republican victory!

[Andrew Brod]

A problematic group for Hagan is group 7: those who would have qualified for Medicaid expansion but couldn't when the state rejected it. That may be a natural constituency for Democrats, but the issue is whether the people in it will turn out.

To be sure, with the right messaging, Hagan might be able to persuade them that they'd be better off if not for Thom Tillis. But that's a harder sell than taking credit for something good.

[Spag]

"those who support Obamacare for philosophical/etc. reasons."

That is actually group two. I can't imagine a group that supports Obamacare BECAUSE others now have insurance could in any way be separate from a group that supports Obamacare for other reasons. Logically that would mean that there is a group that supports Obamacare for other reasons, none of which is that more people have insurance.

I agree that the Medicaid argument is probably her only card, but as you are aware- and I know you think that they are all wrong- there is a counterargument about long term state and federal costs that will be deployed against her which supplements the philosophical arguments over government expansion. I think that the Medicaid expansion argument is simply preaching to the choir which doesn't help considering that polls put the choir in the minority.

Hagan should look at those polls and focus on the parts of the ACA that people like and instead offer a plan reforming the ACA that eliminates the provisions that are unpopular. Of course that may meaning substantially gutting the program, but that would put her in line with most voters.

[Andrew Brod]

Oh right, my group 6 can be combined into your group 2. Never mind.

There is definitely a counterargument about Medicaid expansion. The difference is that the pro-expansion argument comes from numerous academic and think-tank studies, whereas the anti-expansion argument comes out of various Republican politicians' asses. Whether that distinction can be communicated to the electorate, and whether the electorate will care, are what remain to be seen.

I just thought of another group: those who are paying higher insurance premiums on the ACA exchanges due to Medicaid non-expansion (which is everyone who bought insurance on the ACA exchanges).

[Andrew Brod]

Another attempt at denialism: "It’s not Obamacare, it’s the improving economy."

[John]

Andrew if the employer mandate is no game changer, why was it delayed in the first place?

For what it's worth, I'm not one of these guys who rubs his hands in glee every time bad news on the ACA comes out (such as the court decision this week on subsidies). I agree with you that something had to change with our health insurance in this country. I do not want to "go back to the way things were" as so many people like to say (a view that is, in my opinion, as narrow-minded as any view held by conservatives). I just think the ACA is a very poorly written law that since its passage has been tweaked, changed and delayed at Mr. Obama's whim. Our president believes that laws are merely suggestions which he can disregard as he sees fit.

He has been making it up as he goes along for months and the DC Court of Appeals finally called "bullshit."

[John]

The DC Circuit court, I mean.

[Andrew Brod]

Of course the ACA is poorly written. The Halbig ruling illustrates that. The ACA didn't go through the usual process of bill writing and rewriting and editing and rewriting again. The proximate cause was Ted Kennedy's death. When the Democrats lost their effective majority (59 votes is not a majority when the filibuster is invoked for everything), they didn't feel they could pass a bill that differed one iota from the House bill. It wouldn't pass the Senate with only 59 votes. So they had to pass the House bill, which they could do with 51 votes. As a result, the bill didn't go through a conference committee, etc.

Depending on one's politics, one can blame this on the Republicans, the Democrats, or maybe the filibuster. But regardless of fault, the process obviously produced a badly written bill. So what? It's the law of the land (for now) and it's what we have to deal with.

[Andrew Brod]

As for the employer mandate, it was delayed because it's effectively a tax and people don't like taxes. The only connection between the delay and the employer mandate's importance to the ACA is that its unimportance made the Obama administration willing to delay it.

[Ed Cone]

We had an unsustainable, highly-subsidized system of universal care (emergency treatment for anyone).

We could have addressed it by dismantling it. Can't pay? Bye-bye, go die.

Or we could insist that everyone who can afford it should bear some responsibility for a service they will almost certainly need at some point.

The elected government of the United States chose option two. The particulars of this GOP-bred plan are not perfect, but they beat option one and the status quo ante.

I agree with John about premature victory laps. But there's a difference between a victory lap and noticing that the programs seem to be working fairly well overall and that every major prediction of disaster to date has not materialized.

Pointing out the successes and noting the failed wolf-crying may not be a winning political strategy, but it's the only alternative the Democrats have, because they own Obamacare no matter what.

And in North Carolina, the Medicaid question may help Hagan; certainly recent polls give her hope. Hospital closings are not popular, and the most powerful elected conservative state just saw his namesake get routed in a primary.

It's early yet, but I'd like to see some pro-ACA ads come football season.