It's simply too late to undo what happened in March 2010.
To be clear, the program is still trying to make up ground lost in the first blundering two months of the roll out. And the near-term politics for Democrats may still be bad. But all the efforts at sabotage - trying to convince young people not to sign up, trying to scare people that they'd have their identities stolen, trying to prevent so-called 'navigators' from helping people enroll, refusing to set up state-based exchanges, opting out of Medicaid expansion and generally trying to scare the crap out of people with death panels and everything else so they wouldn't sign up. All had one aim: undermine enrollment to force what health care economists call a risk pool death spiral.
That's when you've got too high a percentage of the old and sick to spread the cost of payouts. Without more young and healthy people, there's no way to effectively spread the risk. Then you have to raise premiums. So the logic of holding coverage is undermined for all but the really,really sick. And pretty soon the whole thing just blows up.
That was the aim. But it didn't work. Relatively little noticed this week, we got the first look at the demographic breakdown of the first round of sign ups (those through Dec. 28th, 2013). They weren't great. 24% of enrollees were 18 to 34. The administration was and is aiming to have 40% of enrollees in that category.
But that's not the end of the story. A key Kaiser Foundation study recently found that the key threshold for Obamacare success was 25% of enrollees in that age group. At that number you could have 1% to 2% premium rises. Not great, but not enough to fundamentally break the program and not enough to cause the dreaded 'death spiral.'
Republicans are confident that 2014 will bring a GOP Congress, and 2016 will bring a GOP President, assuring an Obamacare repeal. I hate to break it to them that by 2016, it's going to be far, far too late.
But let them run on obstruction.
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