Obamacare’s Greatest Political Challenge Is the Uncertainty It Creates

Who's winning, who's losing, and why.
Feb. 5 2014 3:32 PM

What the CBO Report Tells You About Obamacare

There is nothing more certain than people’s fear of uncertainty.

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This is the fix for Democrats running for re-election during the Affordable Care Act rollout. They can find information in the CBO report that helps their case, like the fact that the law has led to no increase in part-time work as detractors have prophesied or that the provision Republicans bash as an "insurance company bailout” actually brings in money, but they also have to address every new round of jitters, which cannot simply be dismissed as the creation of partisan Republicans. 

One sensible approach might be to wait until the law is implemented and stop jumping at the smallest hints about what the future might hold. Or we could at least wait for insurance companies to publish their new premium costs in May. Then we'll know if the law is causing prices to increase. Or we could wait until the fall to see how many more people are now insured. Then we can use that data to make a claim about whether the whole thing was worth it. 

That case for patience is one that administration advisers are making, but they are on shaky ground since they have been projecting their own sense of false certainty about the future, too. After a string of bad ACA surprises, administration officials started touting a good surprise: Health care costs have been declining because of the law, they say. A check may not have fallen out of your last envelope, but the check is in the mail … really. 

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The problem with this nice surprise is that it requires a mix of optimism and creative thinking. It’s clear that health care expenditures have slowed, but a 2013 Kaiser study said the majority of the reduction in health spending came from the recession, not the ACA. Medicare actuaries reached the same conclusion: “There is no discernible impact of the [ACA] legislation on aggregate health spending trends.” The administration’s case, which can be found here, relies on a different way of measuring health care costs. 

If the administration is going to make a case about the future of health care costs based on evanescent evidence, then it can’t complain about people who see doom in these new CBO numbers. The best the administration can argue is that we don’t know what the future holds, but that’s not likely to calm people’s jitters about what might appear in tomorrow’s envelope.

John Dickerson is Slate's chief political correspondent and author of On Her Trail. Read his series on the presidency and on risk. Follow him on Twitter.