Making ACA work seen as key to elections

Unless the Obama administration fixes HealthCare.gov as promised and ensures that healthcare reform is working effectively, the national crisis of confidence in President Barack Obama could have dire political consequences in 2014 for congressional Democrats who supported the law, political observers say.

While national attention has focused on the functionality of the problem-ridden federal Web portal for health plan enrollment in 36 states, the larger political question is whether the president's team can right the ship on the entire Patient Protection and Affordable Care Act by next spring and summer. It has already become an albatross around the necks of congressional Democrats who are up for re-election next fall. It's perilous even for Democrats in states where state-run exchanges are working well and lots of people have been able to sign up for coverage.

It's vital for the administration to fix the federal website problems so millions of Americans can shop for and purchase affordable health coverage. Beyond that, the administration must make sure the exchange plans are drawing a balanced mix of healthier and sicker enrollees to keep premiums down, and that consumers can actually access the care they've been promised after they've received coverage.

Meanwhile, the reform law suffered another blow last week when the administration announced it was delaying online enrollment for one year on the small business exchanges in the 36 states served by the federal website.

Even stalwart Obama allies such as Sen. Al Franken (D-Minn.)—whose state's exchange is working well—are sounding shaky in supporting the ACA. Asked recently what should happen if the federal website isn't fixed by the administration's Dec. 1 deadline, he told Minnesota Public Radio: “I think then we have to consider extending the deadline for the mandate, but let's hope that doesn't happen.” Franken is up for re-election next year.

“This policy has always been a bit of a riverboat gamble that you'd get enough people to sign up for this thing and get a broad-based insurance pool,” said Don Moran, a Washington-based healthcare consultant who served as an Office of Management and Budget official during the Reagan administration.

Given that Obama is in his last term, the biggest gamble isn't for him but for Democrats who have supported the ACA from the start. If the law's rollout continues to go poorly, Michael Mezey, professor of political science at DePaul University, predicted Democrats would lose control of the Senate. That could block Obama's agenda on a variety of issues in his last two years.

“During the shutdown, (Senate Democrats) had incredible unity,” said Dan Holler, communications director at the conservative Heritage Action. “That unity has evaporated and they're all looking for political cover right now.”

Sen. Mary Landrieu (D-La.), who faces a tough re-election battle next year, introduced a bill in November to allow consumers to keep their existing individual health insurance policies as long as they stay current with their payments. After the president announced that state regulators and insurance carriers could allow the renewal of non-ACA compliant plans to existing subscribers for 2014, Landrieu said she still plans to support her bill.

But Mezey doesn't expect to see Landrieu or other Democrats running for re-election, such as Sen. Mark Pryor (D-Ark.), take much initiative to move the legislation, which Obama likely would veto anyway. That's because they can't afford to alienate Obama's African-American supporters whose votes they vitally need in their states. In contrast, a Democrat like Sen. Mark Begich (D-Alaska) can take a more critical stance toward Obamacare, because support for Obama is low there.

“It depends on what their local situations are,” Mezey said. “I think there is a real concern that 2014 can be a replay of 2010.” That's when the Democrats lost control of the House of Representatives, which was attributed at least partly to the controversy over the passage of the healthcare reform law.

Ilisa Halpern Paul, managing government relations director at the firm Drinker, Biddle & Reath, said timing and the American electorate's memory are crucial factors. She compared it to the reaction of pro-football fans at the start of their team's new season. Fans lose confidence if their team suffers a string of losses, blaming the coach and the players. Even if the team wins a few games, it's hard to win back those fans. Of course, everything changes if the team pulls off a late-season comeback.

Obama administration officials must make sure that by spring or summer of next year, the public is generally happy with how healthcare reform is going, and that they have health coverage they are satisfied with. “If that comes to fruition by spring,” Halpern Paul said, “I think the political consequences are blunted.”

Follow Jessica Zigmond on Twitter: @MHjzigmond