Kathleen Sebelius, take a bow. Photographer: Joe Raedle/Getty Images
Kathleen Sebelius, take a bow. Photographer: Joe Raedle/Getty Images

In late September, right before the Affordable Care Act's insurance exchanges opened, Health and Human Services Secretary Kathleen Sebelius said that success for the new law would look like "at least 7 million" enrollees.

The White House spent much of the time between then and now trying to walk back that declared goal, but now it has reached it (ignoring, as the Barack Obama administration mostly does, the question of how many of those "enrollees" have paid or will pay their premiums). Congratulations, Madam Secretary.

Health Insurance Exchanges

Hitting that goal was important as a political matter, and as a sign -- but not a guarantee -- that the exchanges would be actuarially stable. We don't know yet how many of them will be: We'd need to know the mix of healthy and sick enrollees in each state to make that judgment. We also don't know for sure how many of the enrollees were previously uninsured. And we want to know how well the law has done in achieving its larger goal of increasing coverage, not just of making itself sustainable.

But it's clear now that one scenario with a lot of purchase among conservative opponents of Obamacare -- that the law would "implode," "collapse" or "unravel" -- is highly unlikely. A quick death spiral was always a remote possibility, even if the early troubles of the exchange websites made it look a little less remote. Many congressional Republicans wanted to believe the idea, though, especially because they viewed it as one more reason they could avoid coming up with their own health-care agenda. (This was illogical -- if the program was going to self-destruct in months, wouldn't the country need a replacement ready? -- but the psychological impulse was to avoid grappling with health-care issues.)

Supporters of Obamacare see the enrollment numbers as more evidence that the law is here to stay. Of course, those numbers don't give us any reason to think that the law will do a lot of good at a reasonable price, or that its basic structure can be modified to pass that test. But the supporters are right that meeting the target of 7 million enrollments will make repealing and replacing the law harder.

The likelihood of replacement would be higher if there was an alternative that didn't take away people's insurance -- one that promised to cover roughly as many people as Obamacare does, or even more. Letting people on Medicaid buy into the market by converting much of the program into tax credits, for example, would be more viable than just kicking its new beneficiaries off the rolls.

Opponents of Obamacare should always have been thinking along these lines. Now they have less and less choice.

To contact the writer of this article:
Ramesh Ponnuru at rponnuru@bloomberg.net.

To contact the editor responsible for this column:
Timothy Lavin at tlavin1@bloomberg.net.