For many months after the Patient Protection and Affordable Care Act -- aka Obamacare -- became law, it was mainly the measure's conservative opponents who ruefully contemplated then-House Speaker Nancy Pelosi's remark that "we have to pass the health care bill so you can see what's in it." Opponents anxiously wondered if people might actually like what they found in the law once it was on the books. If that occurred, odds were good Obamacare would never be repealed. And there would be no stopping government takeovers of other major sectors of the economy.
More recently, as revelations have accumulated concerning what could happen once Obamacare is fully implemented, it may well be the measure's liberal proponents who have the most to fear from learning more about Obamacare. The report released Thursday by the Congressional Budget Office could only magnify such fears because the analysis devastated President Obama's most frequently uttered claim on behalf of his health care reform: "If you like your present coverage, you can keep it."
Rather than accurately describing a key feature of his proposal, Obama's reassuring claim was calculated to ease fears of the unknown among millions of Americans who worried about what might happen to them and their families under a complicated, bureaucratic health care program. After all, why worry about things like those new government-run health insurance exchanges if you get to keep the health insurance coverage that you like?
Now comes CBO saying that a computer model used by it and the Joint Committee on Taxation to project the impact of changes in federal health care policy could result in as many as 20 million Americans losing the insurance they currently have through their employers. A more likely outcome, according to CBO, would be only 5 million people losing their present coverage. But whether the actual total proves to be 20 million or 5 million or some figure in between, such losses undermine Obama's credibility with large numbers of people who were previously willing to give him the benefit of the doubt.
Politically damaging as such an outcome would be to the president's re-election campaign, however, there is a qualifier buried deep in the CBO report that should keep Obamacare backers wide-awake at night. "Models of the health insurance system, including those developed and used by CBO and JCT, are generally based on observed changes in behavior in response to modest changes in incentives, but the legislation enacted in 2010 is sweeping in its nature," CBO said in a classic Washington CYA formulation.
"Given the high degree of uncertainty, some Members of Congress have asked how CBO and JCT's estimates of the effects of the ACA on health insurance coverage would differ under alternative assumptions about the behavior of employers. The analysis presented in this report is illustrative of a wide range of possible outcomes regarding employers' behavior but does not reflect all of the dimensions of uncertainty inherent in CBO and JCT's projections of insurance coverage," CBO continued. In other words, the congressional authors acknowledge that nobody can be certain just how bad things will be once Obamacare is fully implemented.