That forecast will probably come true over time -- though perversely, the exchanges' malfunctioning in the early months probably made more people aware of them in the first signup season. Meanwhile, the political insight underlying the forecast -- that most people pay very little attention to government initiatives and political battles -- makes me wonder about a shorter-term political question.
The refusal of Republican-led states to expand Medicaid has created a cruel and arbitrary gap in the ACA's insurance expansion. Millions of people earn too little to qualify for subsidies to buy private insurance plans on the exchanges (the threshold is 100% of the Federal Poverty Level, but have been denied the access to Medicaid that the law envisioned. Many of these people are going to ACA signup events and lerning that the law affords them no help.
Whom will these people blame, and hold accountable? The wrong party in many cases, if an anecdote in today's Times is indicative:
Ms. LaFerla, a divorced full-time student in social work at Fontbonne University [in St. Louis], receives $7,000 a year in rent payments from her housemates, she said. As a childless adult, she is not eligible for traditional Medicaid, and her income is too low for her to qualify for a subsidy. She shopped on HealthCare.gov and was quoted a $450-a-month premium with a $6,300 deductible.It is of course Republican governors and legislatures that have refused to expand Medicaid despite 100% funding from the federal government in the first two years and 90% funding thereafter. But as with the economy, the president is held responsible for all. The Republican response to the ACA illustrated, so memorably by Tom Toles has been politically effective on many fronts.
“It’s been a big disappointment,” she said. “A lot of us voted for President Obama because we thought this was going to be a good thing.”