But it does mean Obamacare is not what we thought it would be. It’s a much more modest add-on to the pre-existing system. Sarah Kliff put it well in Vox: “Obamacare’s insurance expansion is on the path to looking like other safety net programs we know, offering limited services to a predominantly low-income population.”
Kliff quotes former administration official Michael Adelberg: “The exchange population — 85 percent of which qualifies for financial assistance — looks a lot like the Medicaid population. And with it, we’re seeing the start of the Medicaid-ization of exchange plans: narrow networks with no frills.”
Again, this is not bad. But we’d have had a very different debate if we knew the law was going to be a discrete government effort to subsidize health care for more poor people. For one thing, Democrats would have probably paid a much smaller political price if their effort wasn’t billed as an extravagant government grab to take over the nation’s health care system. The administration imagined something transformational; it ended up with something significant but incremental.
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