The Affordable Care Act, best known as Obamacare, appears to have overcome controversy during its troubled rollout. By the late March deadline, an estimated 7.5 million Americans had signed up to obtain coverage through the program’s insurance exchanges, the result of a last-minute surge in order to avoid penalties. An additional 3.5 million people have signed up for Medicaid.
“The final score speaks for itself,” President Barack Obama has said, insisting that this larger-than-expected figure is emblematic of the law’s success, demonstrating that it is “here to stay.” Although the program is “still not perfect”, its uneasy implementation is “what change looks like in a democracy. Change is hard. Fixing what is broken is hard.”
Several stages of the law’s rollout have been delayed in recent months, presenting the administration with substantive challenges. Most conspicuously, the government’s “healthcare.gov” website failed to operate properly during its October launch. In July 2013, a provision mandating that businesses with more than 50 workers must provide insurance was delayed until 2015. In February of this year, however, the mandate was delayed for yet another year, until 2016.
The biggest administrative change yet for Obamacare came after the March sign-up deadline, when Kathleen Sebelius announced her decision to resign from her post as secretary of health and human services. Secretary Sebelius endured heavy media flak during the healthcare.gov “debacle”. At the time, President Obama stood firm against calls for her to resign, but by March she felt “confident in the trajectory for enrolment and implementation,” according to the White House.
For her replacement, the president has nominated budget director Sylvia Mathews Burwell, whose nomination hearings will be a venue for Republicans in Congress to air out their concerns. Senator Ted Cruz (R-TX) has said that the hearings will be “an ideal opportunity to examine the failures that are Obamacare.”
For Democrats, Sebelius’s resignation represents the program’s success. The fact that Sebelius is not irreplaceable, that a new team under Burwell could take the helm, shows that she eventually “got the job done.” With initial enrollment complete, the Obama administration can afford to make administrative changes without compromising the law’s continued rollout. For Republicans, on the other hand, Sebelius’s resignation is simply a sign of defeat, and prominent Senators John Cornyn (R-TX) and Ted Cruz have mocked the Democratic narrative.
Since Obamacare’s passage in 2009, Republican lawmakers have voted over 50 times to repeal, tweak, or replace the law. Their efforts have been more or less unsuccessful. Dylan Scott of Talking Points Memo notes that most of the possible changes to Obamacare have already been made—not by Republicans, but rather by the White House. This has included delays in the mandate for businesses with over 50 workers. Scott argues that by acting unilaterally to relieve tension from this mandate, the Obama administration has made sure that “Republicans are unable to take any credit for providing relief from the mandate.”
The real battleground will be fought in the run-up to the November midterm elections. At that point, budget projections, website scandals, and political appointments will matter far less than competing narratives over the president’s signature healthcare program.