On the Future of "Obamacare"
This post by Jonathan Bernstein on Obamacare vs. the ACA is interesting. It suggests that Romney’s ACA-like reforms in Massachusetts are not in and of themselves fatal to Romney’s candidacy, because Republican primary voters don’t hate the regulate-subsidize-mandate healthcare policy, but rather hate “Obamacare”, what with the death panels and government takeovers. This argument hinges on the notion that opposition to Romney is mostly culturally-driven rather than policy-driven, and Republican primary voters living in the Fox-bubble-reality have only vaguely-defined notions of what either consist of.
I would posit that if this argument is true, it suggests Obamacare would survive a Romney presidency mostly intact. The individual mandate is the focus of much ire, but the Republicans will run into a firestorm of opposition from the insurance industry if they try to repeal it. If the mandate stands, then they will likely run into massive popular opposition if they try to get rid of the subsidies or pre-existing condition protection while leaving the mandate intact. Most likely they would simply end the Independent Payment Advisory Board (a shame!), say they had shut down the death panels and ended the government takeover of medicine, and everyone would go home happy. Obamacare would be much more secure if it were already delivering benefits, but this perception of Republican priorities suggests the basic structure is safe.
The wild card is what might happen if this is all true so far…but the Supreme Court invalidates the individual mandate during the 2012 election. I consider this unlikely, as it would be rightly seen as naked politicking…but on the other hand, Bush v. Gore. If the mandate were repealed by judicial fiat, the situation becomes much more unpredictable. Insurance companies would suddenly be in a financially untenable position, and as I’ve said I think the repeal of guaranteed issue is unlikely. It seems at least possible this could end up causing the death of private insurance over the medium term.