Four years later, as the program that all sides now dub “Obamacare” stumbles through its tortuous implementation, the furor over the rollout of the federal online insurance exchange has obscured a larger, more fundamental truth: If the program was going to fulfill all that Obama pledged, not everyone was going to come out ahead—someone was going to have to pay the freight. Some subgroups of Americans were going to be worse off than they were before.
Obama didn’t say that in July 2009—or any time while the program was being debated in Congress. He couldn’t. He couldn’t stand up before the American public and say that the only way to achieve the program’s goals was to reallocate money within the health insurance market. That there would need to be a transfer of wealth—from the young to the old, from men to women, from the healthy to the sick. That to raise the floor, you had to lower the ceiling. To do so would have handed his enemies the kind of weaponry they craved, validation that Obama was indeed some sort of “socialist” who believed in “redistribution.” It could have killed the effort in its tracks, then and there, making the tea-party eruption in town halls across the country in the month that followed look like a Kiwanis meeting.
And had the federal insurance exchange launched this fall with a minimum of fuss, it’s possible the sausage-making machinery of Obamacare might have been obscured. If some of the millions of consumers who had received cancellation notices from their insurers in the past few weeks were able to jump on the Web, select a new plan, and ensure continuity of care, it might have alleviated some of the political damage to the administration, even if those consumers were forced to pay more for their new plans.
But that hasn’t happened. Instead, the websites’ woes sparked a media feeding frenzy that filled the airwaves with middle-class citizens relating heartrending tales of canceled policies and rate hikes, adding to the perception, fair or not, that the entire program is in deep jeopardy, or at the very least is some sort of scheme that will either collapse or soak consumers and taxpayers alike. The curtain has been yanked back to expose the ungainly reality that lies at the very heart of the program: Very simply, under the Affordable Care Act, there are winners and there are losers. And there were always going to be. That fact, even more than the star-crossed rollout, may be the more enduring political threat to Obamacare.