Four possible Obamacare futures

3. Obamacare is largely a disaster, but it survives, and possibly expands

Though I’ve written a lot over the past several years about the likely negative consequences of the law, no matter how chaotic the implementation, at some point at least some constituency of voters will be deriving some benefits from the law. It’s one thing to support repeal when it means voting against theoretical subsidies for theoretical beneficiaries. But once the law goes into place, repealing the law would mean stripping away benefits from people actively receiving government aid. Let’s say, in 2017, there’s an incoming Republican president with – at best – control of the House and a narrow Republican Senate majority. Would he or she be willing to use reconciliation to push through a repeal bill when confronted with Democratic attacks that it would take millions off the Medicaid rolls and make millions more lose their subsidized private insurance? Republicans have not traditionally shown themselves to have the political fortitude to roll back entitlements once they are in place. At the same time, if Republicans do not respond with an alternative to clean up the mess, then liberals will begin to blame problems in the health care sector on the idea that Obamacare left too much control in the hands of private industry. This will prepare the groundwork for a further move toward a socialized single-payer health care system, perhaps by, say, re-introducing a “public option.” There have been many times in American history when failures of government policy led to further expansions of government. Limited government advocates should be wary of this happening with Obamacare.