Strategy of delaying Obamacare

Joan Vennochi

Friday, Aug. 23, 2013 | 2:03 a.m.

When he speaks, President Barack Obama is more passionate than ever about the Affordable Care Act — or Obama­care.

But his actions send a different message — delay if not retreat.

First, large businesses got a one-year reprieve from providing health insurance to employees. Then, some insurers got a break: a one-year reprieve before consumer costs are capped.

In that presidential foot-dragging, the political right sees proof that health reform is unraveling, with help from its creator. Privately, some liberals agree. Publicly, however, they say don’t worry.

John McDonough, a key architect of both the federal law and Massachusetts health care reform, recently blogged about “when to get nervous about the ACA.” His conclusion: It’s not nail-biting time.

The delays are insignificant, insists the Harvard public health care professor. “Look who is screaming about it,” he said via email. “All the folks who desperately want Obamacare to never be implemented and who will grasp onto any piece of news, no matter how big or small, or cry ‘train wreck’ as they offer nothing to the tens of millions of unfortunate Americans who will benefit from the law.”

However, even true believers such as McDonough will get nervous if the next piece of Obamacare — the individual mandate — is delayed or postponed. Jan. 1 is the starting point for the mandate, which requires every citizen to have health insurance. If that’s delayed, “count me among the worry warts,” McDonough blogged.

Delaying the mandate, he explains, “would have a cascading negative effect on the whole structure and significantly increase the cost of individual health insurance.” In plain English, that means disaster.

But — given the delays already granted — implementing the individual mandate Jan. 1 raises other questions. Where does the mandate leave average citizens? Business won’t have to provide insurance, and costs to the consumer won’t be capped. Meanwhile, citizens who don’t get insurance are subject to penalties under the federal law.

But Philip Johnston, another Massachusetts health care consultant who fought for reform on the state and federal levels, doesn’t worry about that either. The penalties, he predicted, “won’t be enforced very aggressively. That was the experience here in Massachusetts.”

As for delays already granted by the Obama administration, “Politics to one side, it makes sense to have those delays to make sure the operational part makes sense,” Johnston said.

But no one’s pushing politics aside, including Obama. To dramatize the stakes, he’s framing Republican calls for defunding Obamacare as more craziness from the radical right. During his recent press conference, the president spoke with unusual passion about the right’s fixation on undermining Obamacare: “I think the really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their Holy Grail. ... The one unifying principle in the Republican party at the moment is making sure that 30 million people don’t have health care and repealing all those benefits.”

As for those Obamacare delays, take your pick of theories:

By embracing them, Obama is wisely placating business interests. That gets him through midterm elections without firing up conservatives to the disasterous point of losing the Senate and facing the real prospect of constant funding battles to keep Obamacare afloat.

Or, he’s caving into business by agreeing to delays that will ultimately gut his crowning achievement. After all, business interests had three years to get ready for Obamacare. Why let them off the hook now?

True believers take comfort in history, when Medicare and Medicaid were enacted and then implementation was delayed. “The same kind of questions were coming then from Democrats in Congress,” Johnston said.

There’s some risk in Obama’s approach. If Republicans regain control of the Senate, Obamacare will have less of a foothold because of the delays embraced by the president. With Republicans in charge, Congress could theoretically vote to repeal Obamacare.

The left says that won’t happen, and, if it does, Obama would veto it anyway. In the meantime, liberals argue, he may look like he’s undercutting his legacy, but the real mission is to preserve it.

They still believe in hope. That could change, depending on how Obamacare plays out.

Joan Vennochi is a columnist for the Boston Globe.