Skeptical young Americans not falling into line with Obamacare

by Ross Douthat, New York Times, reprinted in News and Observer, December 9, 2013.

Liberals have decided that it is safe to feel optimistic about Obamacare again.

Not, mind you, because the website’s flaws have all been wiped away, or because the pace of enrollment is where the White House wanted it to be, or because the political backlash over plan cancellations has disappeared. The site may be better, the enrollment pace higher, the backlash no longer front-page news – but the law’s rollout is by any reasonable definition still a dreadful mess.

But a worst-case scenario, in which the website remained unusable well into the new year, seems to have been averted, and with it the danger that insurers or congressional Democrats would begin to bail on Obamacare entirely.

And liberals have apparently decided that just getting things moving in the right direction makes all the difference. Sure, problems persist, crucial errors remain and confusion probably looms for some customers and insurers in January, when policies are supposed to take effect. But errors can be fixed, money sluiced around, more temporary changes made. The important thing is there will be no immediate political unraveling … which means that enrollment will keep rising … which means that, by 2016, Obamacare will be a locked-in, impossible-to-repeal feature of the American landscape.

This holds true, liberals have begun telling themselves, even if the law’s disruptions cost Democrats dearly in the 2014 midterms. Because a working website will give the White House “three full years to create millions, and perhaps tens of millions, of winners who are getting insurance or protection,” The Washington Post’s Ezra Klein wrote last week, Democrats can “lose on the politics in the midterm election even as they win on the policy in the long term.”

The entrenchment hypothesis is plausible. But it elides one crucial problem: the extent to which the successful implementation of Obamacare actually depends on the law’s political standing.

That’s because the law can work only if people who don’t necessarily benefit immediately from its provisions decide to participate anyway. If they respond to higher premiums by either staying out or dropping out, then Obamacare will be permanently unstable: The dollar figures, both for insurers and the government, simply won’t add up.

The participation of the young and healthy is supposed to be required, of course, by the individual mandate. But the mandate’s penalty is relatively modest and its enforcement mechanisms relatively weak, which means its power ultimately depends more on civic duty than on immediate self-interest.

The law’s advocates have explicitly acknowledged this point. Explaining the case for the mandate last month, The Atlantic’s Matt O’Brien allowed that “a rational self-maximizer” might decide to pay the fine instead of buying costly coverage. But “real people,” he argued, “aren’t rational self-maximizers … We don’t like to feel like we’re doing the wrong thing. We like to follow the rules instead. Feel like we’re a good person.”

The experience of Mitt Romney’s Massachusetts, O’Brien concluded, shows how this works: Enrollment in Romneycare spiked when the mandate kicked in, and it spiked for healthy people – presumably because they accepted the “positive responsibility” of the mandate, and bought health insurance because it’s what they were “supposed to do.”

But this example does not necessarily bode well for Obamacare’s unfolding. The Massachusetts law was a bipartisan bill passed in a wealthy, homogeneous state with a pervasive left-liberal ethos. The national health care law aspires to create the same sense of “positive responsibility” in a much more polarized, fragmented, socioeconomically diverse and libertarian-minded society, roughly half of which opposes the law outright.

This was always going to be a lift even without technological problems and “if you like your plan, you can keep your plan” disillusionment. Now it’s much, much heavier.

Consider the findings of a new poll from Harvard’s Institute of Politics. Among the traditionally pro-Obama millennial generation, the core group that the White House needs to “follow the rules” and buy a policy, the president’s approval ratings have dropped to 41 percent, and support for Obamacare has also plunged: 56 percent of 18- to 29-year-olds disapprove of the law, a majority say it will increase costs and just 18 percent say it will improve their care. Meanwhile, a new National Journal survey finds that a majority of millennials expect the law to be repealed outright.

Those are not numbers that suggest a population that’s poised to fall in line, do its civic duty and feel warm and fuzzy in the process. Rather, they suggest that the political emotions stirred up by the rollout – frustration, disillusionment, anger – could have substantial consequences for sign-up rates as well.

“If there’s one thing we know how to do,” said a White House official last spring, projecting optimism about Obamacare enrollment, “it’s reach young people.”

Now, though, the fate of their policy may depend on not only reaching them, but reconverting them as well.