Republicans double down to kill Obamacare, but can they?

Washington has erupted into open, partisan warfare.

Senate majority leader Harry Reid’s decision to push the button Thursday on the so-called “nuclear option” – allowing most presidential nominees to proceed to confirmation with a simple majority vote rather than a 60-vote supermajority – is just the latest example.

The Democratic leader’s move, long threatened by both parties but not acted upon until now, will have a profound effect on how the Senate works. But it probably won’t resonate much with the public, which pays scant attention to Senate procedure.

The larger war under way is over Obamacare, and the outcome is less certain than it might appear.

Yes, President Obama and the Democrats seem to be losing that one badly. HealthCare.gov still doesn’t work reliably, and likely will not by Nov. 30, when the administration promised it would work for the “vast majority” of users. Public approval of the Affordable Care Act (ACA) is sinking. To great embarrassment, HealthCare.gov greeted Health Secretary Kathleen Sebelius with an error message Wednesday at an event promoting the ACA.   

Americans are still receiving cancellation letters on their substandard health plans, and because HealthCare.gov doesn’t work smoothly, some can’t tell if they’re eligible for subsidies on a new plan.

But the site will work sooner or later, and then what?

In a memo to House Republicans this week, publicized by The New York Times, GOP leaders have mapped out their game plan.

First, the talking points: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.”

Then, the marching order: “Continue Collecting Constituent Stories.”

The Republicans’ goal, it appears, is to smother the baby – the ACA – in the cradle, by hyping all the negative story lines so loudly that the less-motivated (i.e. healthy), uninsured people steer clear of HealthCare.gov, leaving the marketplaces heavily tilted toward less healthy people. The insurance market goes into a “death spiral,” and then poof, that’s the end of Obamacare.

But not so fast. The ACA includes safeguards for the first three years against what’s called “adverse selection” – the tendency of the most risk-prone people to buy insurance.

The law contains two types of risk mitigation: risk corridors, money available to help insurers if their policies are too heavily weighted toward less-healthy customers; and reinsurance, a $10 billion fund collected from insurers to help pay the cost of customers with high medical bills.

This means the "death spiral" isn't likely to happen, many experts say.

Moreover, ACA supporters are saying that stories ignored by the media show signs of Obamacare's promise – people who have gotten insurance through the marketplace, in some cases more cheaply than before, and some for the first time in years.

Some 71 percent of people in the private individual health market will be eligible for subsidies, said Ron Pollack, executive director of Families USA, which has fought 30 years for universal health coverage, in a conference call Thursday. And looking at the nonelderly American population as a whole, he said, less than 1 percent – 0.6 percent – are at risk of losing their current plan and paying more for new coverage.

Mr. Obama’s inaccurate claims that people who liked their plan could keep their plan need perspective, Mr. Pollack added.

“When the president says something that turns out to be not quite accurate, it deserves attention,” Pollack said. “I do think, however, this issue has been blown out of proportion.”

If groups like Families USA are right – if the safeguards built into Obamacare will help it weather any storm – then are the Republicans the ones playing with fire? ACA supporters will certainly try to turn the narrative on them: Are Republicans interested in helping people who want health insurance but can’t afford it? The solution, Republicans say, is a more market-based system. But the 17-page memo to House Republicans, put out this week by House majority leader Eric Cantor (R) of Virginia, makes no mention of a GOP alternative.

Meanwhile, Republicans remain relentlessly on message decrying Obamacare. At a Monitor breakfast on Nov. 15, Rep. Greg Walden (R) of Oregon made it clear that Obamacare would be the all-purpose message of Republicans in the 2014 midterm elections, no matter the race.

“Now it has become a Category 5 political hurricane that is not just causing havoc in certain regions of the country, it is ripping apart every region of the country in tiny hamlets and towns and major cities where people are finding confusion, chaos, cancellation, [and] cost increases,” said Congressman Walden, chairman of the House Republican campaign committee.

On Thursday, after Senator Reid made his move on filibuster reform, the minority leader, Sen. Mitch McConnell (R) of Kentucky, accused him of trying to deflect attention from Obamacare, then went on the attack.

“Here’s the problem with this latest distraction,” Senator McConnell said. “It doesn't distract people from Obamacare. It reminds them of it. It reminds them of all the broken promises. It reminds them of the power grab.”