Having failed to beat the Affordable Care Act in Congress, in the courts, or at the ballot box last November, conservative opponents have one last chance to beat it on the field of reality. Republicans see the delayed implementation of the law’s poorly designed employer responsibility provisions as a sign that the law is fundamentally unworkable and will unravel,as long as conservatives keep up the fight. The White House, not surprisingly, disagrees. At a briefing I attended last week, senior administration officials painted an upbeat view of the implementation process and expressed eagerness to shift the focus off the political controversy and onto how the law will have concrete impacts on citizens’ lives.
In the short term, I doubt they’ll get their wish. Putting something as big as Obamacare into practice is bound to hit snags. Between conservatives keen to exaggerate problems for political gain, liberals keen to highlight shortcomings in order to make sure people get help, and journalists who know conflict is a better story than people being happy, the year ahead should still be full of rancor and negative press. But in a larger sense, I think the administration has this right. It’s forgotten today, but the launch of Medicare in the mid-1960s was full of hand-wringing about implementation. So was the addition of a prescription drug benefit a decade ago. The Affordable Care Act has key features in common with those undertakings: It gives a lot of money to a lot of people, which means it can fall short of becoming perfect policy by a fair margin and still be popular and successful.