Medicare Part D's Hopeful Lessons for Obamacare

The rocky rollouts of the two laws were strikingly similar. The big difference this time around is an opposition party with its mind set on sabotage.
Kevin Lamarque/Reuters

Congress is back—and the House has an ambitious plan for the year ahead. OK, an ambitious plan to cement its place in history as the Do-Nothingest Congress of all time.

The House has scheduled all of 97 days in session before the November elections, with many of them being half days or pro forma ones. And Majority Leader Eric Cantor's memo to his troops outlining the plan for the year ahead made it clear that there is at most a bare-bones agenda, focused like a laser, yet again, on repealing or further sullying and delegitimizing Obamacare. The only possible good news coming out of that is that the obsessive focus on killing Obamacare may provide the excuse for House leaders to extend the debt ceiling without blackmail this time, by convincing their rank and file that it is the best way to avoid distractions and keep the focus on the health-insurance law.

The obsession with Obamacare, and the near-universal belief among Republican lawmakers and conservative spinmeisters that the law will collapse spectacularly of its own weight, is fascinating.

Remember that when Senator Ted Cruz incited the shutdown last year over the demand to defund Obamacare, his argument was that this was the last chance before the law was implemented in January—after which it would be impossible to stop it, because so many Americans would be delighted with its benefits. Cruz told Sean Hannity last July, "If we don't do it [defund Obamacare] now, in all likelihood, Obamacare will never, ever be repealed. Why is that? Because on January 1, the exchanges kick in, the subsidies kick in; ... their plan is to get the American people addicted to the sugar, addicted to the subsidies, and once that happens, in all likelihood, it never gets …"

At which point Hannity agreed, saying, "It's over—it never gets repealed."

The awful and bumpy rollout of the plan changed all that; now, for Cruz, Hannity, and everyone else in the right-wing echo chamber, there won't be any highs ahead, or at least the highs and sugar addictions will be overwhelmed by bad drugs and overdoses.

Which view is right? We don't know for sure, but there is some interesting evidence in the rollout of the Medicare Part D plan in 2005, via an excellent analysis by Georgetown University's Center on Health Insurance Reform. The report makes clear that there are many parallels between Part D and Obamacare.

First, both plans passed with substantial partisan tension, which tarnished the initial public views of them. Second, both plans created much confusion in the public, with small proportions of Americans having even a basic understanding of what was in the plans and how they would work. Third, both plans had a lot of time after passage and before they actually took effect to prepare for a massive rollout. Fourth, neither had its website ready to roll when the deadline hit, and both had crashes and long delays to gain access. Fifth, even after the websites became more reliable, other problems persisted, including inadequate call centers and inexperienced navigators at the local level who were unprepared with full or sophisticated answers to questions posed by those trying to sign up. Sixth, supporters of the laws issued cautions when they were first unveiled, warning of glitches ahead and asking the public for understanding and help at ameliorating the problems.

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Norm Ornstein is a contributing writer for The Atlantic, a contributing editor and columnist for National Journal, and a resident scholar at the American Enterprise Institute for Public Policy Research. More

Ornstein served as codirector of the AEI-Brookings Election Reform Project and participates in AEI's Election Watch series. He also serves as a senior counselor to the Continuity of Government Commission. Ornstein led a working group of scholars and practitioners that helped shape the law, known as McCain-Feingold, that reformed the campaign financing system. He was elected as a fellow of the American Academy of Arts and Sciences in 2004. His many books include The Permanent Campaign and Its Future; The Broken Branch: How Congress Is Failing America and How to Get It Back on Track, with Thomas E. Mann; and, most recently the New York Times bestseller, It's Even Worse Than It Looks: How the American Constitutional System Collided With the New Politics of Extremism, also with Tom Mann.

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