The Affordable Care Act (ACA) is President Barack Obama’s landmark legislative achievement. The White House decision to embrace the term Obamacare may be one of his worst political stumbles.
To be fair, it was the President’s opposition that coined “Obamacare” and started using it as a pejorative. Somewhere during the campaign season, the Obama folks decided they might as well accept the terminology and try to sell Obamacare as a good thing. The trouble is, that made sure the term would stick and it gave license to the media to use “Obamacare’ as shorthand for the Affordable Care Act.
The first mistake, of course, was not to give health care reform legislation a memorable name in the first place. Something like “Americare” or “Health Security’ might have caught on and saved the White House a lot of grief. The Affordable Care Act is a name that could only come out of Washington or an ad agency working for a shady insurance company. No real person uses the term affordable in their everyday speech. They might say “cheap” or “inexpensive.” But “affordable” ? Give me a break. It’s almost as warm, fuzzy and understandable as “sequester”.
It isn’t just naming the health care reform law where White House communication broke down . They Administration never successfully articulated what is in the program and why it is needed. The health care system in America was in shambles, with spiraling costs hitting patients, employers and providers. Businesses were pulling back on insurance for their employees and benefits weren’t getting any better, even as the cost to employees kept going up. This was an area where the President failed to connect the dots and demonstrate that employer health care costs were—and are–unsustainable and that employment and economic growth were being strangled by the cost of health insurance premiums. Health care reform should have been billed as an integral part of the President’s economic recovery agenda. It wasn’t.
The most troubling aspect of the term “Obamacare” is that, in a highly polarized political environment, partisanship attaches itself to the program itself. Support and opposition to the ACA in the polls follow party identification and the program’s favorability and unfavorability trend along with the President’s popularity. Social Security and Medicare were every bit as controversial as the ACA, but they weren’t identified solely with Franklin D. Roosevelt or Lyndon Johnson. After a few years of implementation and the realization that the dire warnings were groundless, these two big programs settled in and were accepted by the American people. This scenario seems far less probable for “Obamacare”. GOP passions against the President are too deep to expect that the Republicans in Congress will ever let go of this bone.
Some compare “Obamacare” to “Reaganomics”, but one plan is a program enacted into law and the other is a policy strategy. And remember, Reaganomics only worked with that President’s base and was held in some derision across the aisle.
There is no evidence of a Republican plan to replace the ACA, which was, of course, based on policies and programs advocated by Mitt Romney and the Heritage Foundation. The GOP’s current goal seems simply to sabotage the program and make sure that it never gains a foothold that would allow it to run smoothly. House Republicans and some GOP senators appear to see this as their only mission and have no qualms about shutting the government down or having it default on its debts in order to make that happen. Most GOP members of Congress represent hard-core Republican constituencies and opposing a program that bears the Obama name of can only win them points back home.
None of this means that the Affordable Care Act is doomed. Although there may be some rocky spots during the transition, the results in California and other states that have gone forward are encouraging. Republicans in Congress have an extraordinary ability to overreach and if they go ahead and throw another tantrum over health care reform and shut the government down, they will be paying a big political price for years to come.
Although there will be tweaks along the way, the ACA is likely to be the framework for health care in America for the foreseeable future. It would help if this system could run without the political baggage.