Some Democrats hope to minimize the importance of Obamacare as a political issue by focusing on other topics in this November's midterm elections. Some hope to win by promising to fix the flawed national health care plan they passed in 2010. And others hope to turn the issue on Republicans by appealing to voters who have been helped by the law.
The problem is, none of that will work. The importance of Obamacare as an issue in November 2014 cannot be controlled by either political party. It will be determined by just one thing, and that is the performance of Obamacare as a law in the months preceding the election.
The Obama administration obviously understands that. There is no other explanation than political expediency for its announcement last week that it is extending the "keep your plan" fix until 2016 for Americans who have coverage that doesn't meet Obamacare's minimum standards.
The administration knows that the same kinds of cancellations that happened to holders of individual policies over the winter will happen later this year to people insured in the small group market. That could be a lot of newly-angry voters. So the White House put it off until after Election Day.
The administration did not take action because it feared Republicans might gin up some fake health care controversy to be used against Democrats. It took action because it knew Obamacare was going to impose new burdens on millions of Americans with an election approaching.
Obamacare is touching more and more Americans. Remember that chart cited by some liberal commentators suggesting that 80 percent of Americans would be entirely unaffected? Recent studies are showing something much different.
A survey by the Kaiser Family Foundation in February found that 54 percent of those interviewed said they have "not been personally impacted" by Obamacare. That number was down from 59 percent in January and 64 percent in December 2013. It will probably continue to fall; the 80-percent-unaffected idea was always a fantasy.
Meanwhile, Kaiser found that the number of people who say someone in their family has been "negatively affected by the health reform law" has climbed to 29 percent, up from 26 percent in December. Finally, the number of people who say someone in their family has "personally benefited" from Obamacare is at 17 percent, up from 11 percent in December. That's not a good ratio for Obamacare advocates.
Some Democrats, and their supporters in the press, will probably argue that not all those who say they or a family member have been negatively affected by Obamacare have actually suffered any ill effect. Maybe that's true, for some. But telling voters they're wrong is not a particularly effective electoral strategy.
The March 31 deadline for the Obamacare enrollment period is less than three weeks away. Don't expect the administration to reveal much detail about the final numbers. But independent studies will almost certainly show that a large percentage of people who purchased insurance on the Obamacare private market were previously insured, and many who signed up for Medicaid were already eligible before Obamacare.
The news in April, then, will likely be that Obamacare is seriously underperforming at its main job: covering those who don't have coverage. "The uninsured just aren't buying Obamacare," health care analyst Bob Laszewski wrote recently. "I believe they are not buying it because the premium -- even net of the subsidies -- is too much for plans that have deductibles that are too high."
Democrats have to campaign on a platform of changing the law. They don't have any other choice. The Kaiser study found that just eight percent support keeping Obamacare as is, while 48 percent want to keep the law in place but work to improve it, and 31 percent want to repeal it altogether. The only real question about Obamacare is whether people want the law changed or junked. The status quo is not an option.
The problem is, Democrats haven't put forward any good ideas to deal with Obamacare's dilemma of higher premiums, higher deductibles, a burdensome mandate, and narrower choices of doctors, hospitals and prescription drugs. Democratic candidates say they want to fix the system, because that's what they have to say, given voter opinion, but they don't really know what to do.
So they rely on President Obama to put off the bad stuff until after the election. But for millions of Americans, the pain of Obamacare cannot be put off indefinitely. The subject can't be permanently changed. Democrats created the system that is now touching millions of American lives, and they have to live with it.