The debut of the Affordable Care Act has been a case study in Murphy's Law. Not only was the website a technical disaster but the sudden cancellation by insurance companies of existing policies due to the complicated rules of the ACA added insult to injury. This has given the GOP even more ammunition to use against the law, put the White House on the defensive, and sent the president's approval rating plummeting.
It would be tempting, therefore, for the president to shift his administration's (and the nation's) focus from Obamacare towards other matters like immigration reform and clean energy, but that would be a mistake. The ACA, if successful, will not just be a major victory for Democrats but a game changer for America's relationship with healthcare. The president has accomplished many things during his time in office, but his primary legacy will always be Obamacare, and that is what he and his party will be judged on, especially in 2016.
Here, then, is what the president should do to ensure that his landmark achievement does not end in failure, to solidify the position of his party for 2016, and to help all of us:
1. First, slow down his legislative agenda and focus instead on getting Obamacare right. While other issues are important as well, the president must recognize the time limitations of his second term, and the perils of trying to do too much. With midterm elections around the corner, the Democrats are naturally eager to rack up headline grabbing 'wins' that they can use to entice voters in 2014, but after the government shutdown and debt ceiling nail-biter, most Americans are more interested in seeing their government working rather than politicking. By hunkering down and doing the unglamorous work required to fix the problems with Obamacare, the president will be demonstrating his commitment to doing his job, which will ultimately speak much louder to voters than headlines -- even in 2014.
2. Set the record straight about what the ACA can and cannot do. What it cannot do, as the recent insurance cancellations (which are actually automatic migrations of customers to more expensive plans) illustrate, is lower costs for all Americans immediately or at every stage of their life. Marketplace competition is already beginning to lower premiums and government subsidies will provide further relief, but the process will take time to reach critical mass. In any case, the United States currently has amongst the highest per capita expenditure for healthcare ($8,608) in the world, and healthcare spend as a percentage of GDP has grown from 9 percent in 1980 to 18 percent in 2011, so any savings that are realized through the ACA will be a vast improvement over the status quo.
In addition, by requiring everyone to buy insurance, Obamacare effectively spreads out the costs of healthcare amongst all citizens, sick and healthy, old and young, thereby lowering average premiums for the nation. On this point, the president needs to emphasize that even though younger Americans will subsidize insurance premiums for older citizens, the formula will turn in their favor as they get older and need more affordable coverage themselves. Finally, the law will improve the quality of coverage provided by private insurance companies as well as Medicare by mandating coverage of more ailments, ending discrimination on the basis of health or gender, and removing existing limits on coverage.
3. Fix the glitches with the HealthCare.gov website as soon as possible, bolster the infrastructure to really help people understand their options (and to fight the GOP's misinformation campaign), and if necessary, make legislative adjustments to the law itself. Delaying the provision that triggered the cancellations was a good step but addressing the issue more permanently is critical. If this means having to retool Obamacare based on current information, that is a battle worth fighting.
4. Stop apologizing for Obamacare's glitches and instead come out ahead of any future problems. The GOP, or at least the far right fringe of the party, wants to politicize the problems, but they can only make headway if the President dignifies their claims with defensive responses. A better approach would be to lay the ACA and its issues bare in front of the public and then show people how the government will deliver results. Conventional wisdom holds that no one likes to see the sausage being made, but in the current climate, Americans would prefer to see something being done on their behalf than to continue living with inaction and black-box politics.
The GOP's relentless criticism of Obamacare, coupled with the program's disastrous rollout, has skewed the public's perception of the law and its benefits, and hobbled its future. At the same time, it is arguably the single most important piece of American legislation since the establishment of Social Security in 1935, one that holds the key to our nation's health, and one that can make or break the Democratic Party. With all that in mind, the president must keep his focus on the ACA, do whatever is necessary to finish what he started, and do it now.
SANJAY SANGHOEE is a political and business commentator. He has worked at leading investment banks Lazard Freres and Dresdner, as well as at multi-billion dollar hedge fund Ramius. His opinion pieces have appeared in TIME, Bloomberg Businessweek, FORTUNE, and Christian Science Monitor, and he has appeared on CNBC's 'Closing Bell', TheStreet.com, and HuffPost Live on business topics. He is also the author of two thriller novels.
For more information, please visit www.sanghoee.com