Supporters of the healthcare law pointed out that more than 94 percent of large employers already offer health insurance, and that the mandate was unlikely to have had a significant effect. There is no reason to believe that the rest of the reform law will not be implemented on schedule. Opponents of the law, however, crowed loudly that healthcare reform was on the ropes.
Repeated polling has shown Americans deeply divided over the Affordable Care Act. While many support the legislation, more oppose it (some of whom believe the law does not go far enough). But a growing number admit that they simply don’t understand it. Moreover, when polls ask about the specific content of the law, it becomes clear that many Americans who think they understand ObamaCare in fact don’t — they are unaware, for example, that it contains provisions they support, or believe incorrectly that it contains provisions they oppose.
The Affordable Care Act is a long and complex law. Congress could have replaced our cumbersome and costly private healthcare financing system with a public system, like those in other countries, but this was never politically possible. Instead, Congress tried to extend the benefits of our current system to all Americans, covering those with preexisting health problems and offering help to those who cannot afford health insurance. Congress looked to the states, rather than the federal government, to implement much of the law to maintain state insurance regulation. Most working-age Americans are insured through their employers, so Congress also included an employer mandate to preserve and extend this pillar of our system.
The legislation is conservative, built on ideas drawn from Republicans and conservative advocacy groups. Congress passed ObamaCare, however, without any Republican votes, and from the outset it faced adamant conservative opposition. The law was greeted the day it was signed by a lawsuit joined by half of the states. Although the Supreme Court upheld the law’s private insurance reforms, the court deprived millions of the poorest Americans of healthcare coverage by allowing the states to refuse to expand Medicaid. Two-thirds of the states have refused to implement the law’s health insurance marketplaces, intended to promote insurer competition and consumer choice, leaving the job to the federal government. More than one-fifth of the states have refused even to implement the law’s insurance reforms.
The House of Representatives has voted repeatedly to repeal the law. More importantly, the House has refused to appropriate funds needed to implement it. The implementing agencies face a much larger task than initially anticipated because the states have refused to help. Under these circumstances, the administration must make choices. It is focused on getting the marketplaces and insurance reforms in place and, most importantly, the premium tax credits available by Jan. 1, 2014. The employer mandate was not essential to this effort, so it will be delayed.
In our highly polarized political environment, it is not surprising that a comprehensive reform of our healthcare system has proven very controversial. Opponents of the legislation have spent almost half a billion dollars on TV advertising to fan this controversy. The Obama administration has proved remarkably inept at promoting the law and educating the public. But implementation of the law has been made immeasurably more difficult by Congress’ refusal to provide needed resources.
Millions of young Americans already benefit from ObamaCare’s requirements. On Jan. 1, 2014, millions more Americans will be covered by health insurance and Medicaid. This law is far from perfect. But it is the only healthcare reform law we have, or are likely to have in the foreseeable future. Americans need to get accurate information about the law and to give it a chance to work. Healthcare reform implementation hit a bump this week, but it must keep moving forward until it reaches its destination.
Jost is a professor at the Washington and Lee University School of Law and a leading expert on the Affordable Care Act.