Panic may be the quintessential emotion of the modern Democratic Party. And, unlike the recurrent panics that pop up every six months or so, blot out everything, and then disappear — scandals! the Denver debate! Scott Brown! the unstoppable Sarah Palin! — the current sense of dread enveloping the Democratic Party has a very real basis. President Obama’s poll numbers are plunging to unprecedented depths. Few people outside the administration (and not even everybody within it) share the White House’s professed confidence that it can repair its website by the end of the month. The wave of individual market cancellations, without an available alternative on the exchanges, is creating an affluent, influential constituency angry with the law, with hardly any constituency yet mustered in its favor.
It’s in the individual interest of vulnerable Democrats to publicly distance themselves from the administration, and it’s in the collective interest of the party to devise some palliative for angry individual-insurance customers. But the party’s wild scramble for immediate solutions solves neither their collective nor their immediate dilemma, and may make everything considerably worse.
Democrats in Congress are sponsoring, or threatening to join, various proposals purporting to allow people with individual-market insurance to keep their plans. That sounds nice, doesn’t it? But another way to describe this same idea is “Let insurance companies continue to exclude sick people.” After all, the individual-insurance market consists mainly of people without predictable medical needs. Obamacare prevents insurance companies from discriminating against people with preexisting conditions. That’s the most popular goal of the law — a goal so unassailable that Republicans have pledged their fealty to it all along, including such figures as Paul Ryan, most recently as yesterday (“we can have a system in America where people can get access to affordable health care, even if they have a preexisting condition”).
Banning insurance companies from discriminating against people with preexisting conditions necessarily bans them from discriminating in favor of people without preexisting conditions. Those twins forms of discrimination are the entire basis for the currently existing individual-health-insurance market. Preserving that discrimination undermines, at least to some degree, the core function of the new exchanges.
Undermining Obamacare in order to placate angry individual-insurance holders makes no sense even on narrow political terms. People losing individual insurance they like are angry right now, but they’re a tiny minority of the market, and their anger will fade over time as the exchanges come online. Higher premiums would affect far more people, and their impact would be felt much closer to the midterm elections. Imagine it’s next year, insurers are pulling out of the exchanges, rates are rising, all because of a law Congress hastily passed the year before — is that a better situation?
It may be possible to design a fix to the keep-your-plan problem that imposes minimal disruption on the functioning of the exchanges. But Democrats in Congress are rushing out such plans before any experts have a handle on their impact. Ezra Klein asked a couple of health-care experts to assess the keep-your-plan bills, and came away mystified:
How much will premiums rise if Landrieu’s bill passes? No one knows. “It sure would be good to know how bad that problem is,” says Drew Altman, president of the nonpartisan Kaiser Family Foundation. “I don’t feel I know.” Jon Gruber agrees. “I don’t know how much higher premiums go,” he sighs. “I really don’t.”
A health-care expert I consulted was likewise mystified. It’s not even clear that a legislative fix of any kind could work mechanically, given that insurers have spent years planning to switch their individual plans over to the exchanges.
Democrats in Congress appear so convulsed with bug-eyed fright that they refuse to listen to any kind of measured weighing of cost and benefits. They are saying things that sound like stock quotes from movie scenes featuring ignorant, terror-stricken townspeople forming a lynch mob. Here’s Representative Mike Doyle:
“The point I was making in caucus to the administration is don’t give us this techo-babble that you’re going to do some administrative fix down the road. There’s a bill being put on the floor on Friday.”
And here’s Representative Steve Cohen:
“They’re telling us all about actuarial tables and all about how the process would work and all of this is fine and great and it would be great in a classroom and you would get an A on your test, but this isn’t about getting an A on your test, this is about ads.”
Actuarial this, administrative that … put a sock in it, professor! They want ACTION and they want it NOW!
Do these sound like people about to enact sensible policy changes that will leave the system more workable a year from now? Do they even sound like people able to sensibly assess their own political self-interest? Republican strategist Carl Forti, a former top National Republican Congressional Committee official, tells Politico he’s surprised even more Democrats haven’t already fled: “If I’m in Arkansas or Louisiana or North Carolina or Alaska, I’m running for the hills.” It’s possible, just possible, that the National Republican Congressional Committee does not have the best interests of the Democratic Party at heart.