The biggest myths about the Affordable Care Act are found among conservatives who believe that the program is going to collapse on its own -- indeed that the program is already collapsing. That’s simply not happening. Even in places where reform could still go badly wrong, the prospect of “repeal” has been a fantasy for some time now. The old system is gone. A flat-out repeal of Obamacare would cause chaos. It’s not going to happen.
That’s not to say that ACA supporters don’t have their myths, too. They do. And I’m confident that the biggest myth is that somewhere down the road, probably just around the bend, Obamacare is going to be a significant electoral plus for the Democrats.
I continue to think that’s absolutely wrong.
There’s very little evidence that voters total up benefits they’ve received from government and vote for the party responsible for them. Instead, to the (relatively small) extent that voters deviate from partisanship, they’re most likely to reward or punish the incumbent party based on how things are going in general, with the economy usually the biggest piece.
Moreover, we’re right now at the peak of consumer appreciation of “Obamacare” as such. A bunch of people who were frozen out of the insurance market in the past are now entering it, and all of them probably know that the ACA is why. But their numbers are going to decrease rapidly over time.
I heard a great example of that yesterday. In a speech on the Senate floor, Senator Barbara Boxer told the story of a constituent who had been refused insurance because of a pre-existing condition which was, actually, just a false positive on a test at some point. That will never happen under the new system. But no one who receives a false positive for cancer or whatever in 2016 is going to realize that their continued access to health insurance is a result of Obamacare.
In fact, before long very few people will be aware that once upon a time a preexisting condition would have put their insurance at risk. Nor are future 25 year olds on their parents' health care plan courtesy of Obamacare going to be aware that only a few years ago they might have been uninsured. To them, it will just be the way things work. Later, when they go to Healthcare.gov or a state exchange to buy their own insurance, they will perceive it as business as usual -- not as an active government intervention.
Likewise, I’ve never heard anyone in recent years express thanks that their insurance policy wasn’t canceled after they filed a claim. Almost no one realized the threat of rescission existed until it happened.
Now, that doesn’t mean the ACA will be vulnerable to repeal; a lot of people who won’t vote based on what they’ve received would certainly be upset if the exchanges closed and their policies (and subsidies) were cancelled.
It’s just that the law's successes won’t mean much at the ballot box. Indeed, as I’ve argued, it’s very possible that “Obamacare” could be permanently unpopular -- especially if the president has a rough second term -- even while the ACA is largely secure from Republican threats. We are close to the peak awareness of its benefits right now, yet there’s no evidence of a positive shift in public opinion.
Democrats can count on Obamacare sticking around. But they really shouldn’t count on it helping them win elections.