Debate and the Affordable Care Act is no new combination. Signed into law by President Barack Obama in March 2010, the healthcare reform law passed the House of Representatives and the Senate without a single vote from a Republican lawmaker, setting up Obamacare to be the most divisive issue of his administration. Over the reform’s four-plus-year transformation from a campaign promise and healthcare theories to political reality, the Affordable Care Act has played a major role in deepening the rift between Republicans and Democrats. The law’s complexity has lent itself to over-exaggerations by both parties, which, even after the cornerstone provision of the reform — the insurance marketplaces launched last October — has left the American public unsure of its ramifications. The Congressional Budget Office is also unable to fully calculate how the reform will impact the country’s finances in coming years, mostly because so many details of the Affordable Care Act, including the employer insurance mandate, are still in flux. That reality leaves voters largely pessimistic and more open to a barrage of campaign literature both bashing and lauding the reform’s impact on American healthcare system.
To be a success, the Affordable Care Act depends on the proper functioning of essential cogs that, together, make up the massive and complex system of reform. Early measures of the effectiveness of the insurance exchanges at reducing the number of unemployed Americans have showed positive results. But quantifiable measures of performance pillars of the reform have yet to come together to form a coherent narrative of how the Affordable Care Act has improved (or hurt) the American healthcare system. Unanswered questions remain; namely, how sustainable is the individual insurance mandate over the long-term? The budgetary impacts of Obamacare, and its ability to lower overall healthcare costs in America, are still subjects of much debate. As always, the Obamacare debate is not limited to concerns raised by healthcare policy wonks.
Noting that the Obamacare debate has cast a dark shadow over American politics may seem unnecessary, but it is still important to examine how the reform will inform the campaigns of incumbents and challengers, Republicans and Democrats, and representatives and senators. The 2014 congressional midterm elections will be an important checkpoint in the life of the Affordable Care Act. True, analysts will not be able to wake up the Wednesday following election day and say unequivocally that the American cast their ballots in support of the healthcare reform, or to oppose it. However, Obamacare is an important strand in the American political narrative.
Obamacare may not occupy the same position in the national consciousness as it did last fall when the faulty launch of the insurance exchanges created great public outrage, but the broad-based dissatisfaction in the federal government expressed by the American electorate has been profoundly colored by the fight over the healthcare reform. So the main story of November’s elections may be that loss of confidence. Yet, the impact of Obamacare on voters can not be discounted. After all, it is the greatest reform to the American healthcare system since the 1960s when President Lyndon Johnson signed Medicare and Medicaid into existence.