One frustrating feature of the endless debates over the Affordable Care Act is that the positions of Obamacare opponents often turn out to be unfalsifiable articles of faith. I think it’s helpful to think back to November and December, when wasn’t working and the enrollment situation looked dire. If that had continued — if the worst predictions of Obamacare opponents had come true — the law would have faced a real existential crisis going forward. 

But that’s not what happened. There are many, many open questions about the law going forward. This is no victory lap. But people are getting covered by Obamacare. The number of people without insurance is going down. Enrollment met, or surpassed projections. There will be no death spiral. There will be no collapse.


And in the face of these events, the Obamacare opponents who predicted that the law was doomed to a train wreck — certain to collapse on its own, leaving its foes to bathe in the political sunshine of a nation’s anger — well, they have adjusted their position…not at all. Here’s Sen. John Boozman

Changing the point person for a disastrous program won’t provide much relief for the millions of Americans who lost their health care coverage, face skyrocketing costs and can no longer go to the doctor of their choice. The best CEOs in the world can’t implement a bad business plan. It’s no different for public policy. You can put the best administrator you can find in charge of a flawed program and it will still fail. Until we get rid of Obamacare, and replace it with common-sense, market-based reforms, costs will continue to rise and the American people will continue to suffer as a result.

Now that Kathleen Sebelius is out the door, Republicans say, it wasn’t her fault. She was just driving a train guaranteed to go off the tracks, right? “You can put the best administrator you can find in charge of a flawed program and it will still fail,” Boozman writes. But at this point, what Boozman is calling failure is starting to look an awful lot like success if the goal is expanding the number of people in the country with access to health insurance. 


Greg Sargent at the Washington Post collects some other examples of Republican lawmakers singing a similar tune across the country: 

Eric Cantor: “I thank Secretary Sebelius for her service. She had an impossible task: nobody can make Obamacare work.”

Chuck Grassley: “Anybody put in charge of Obamacare would be set up to fail.”

Mitch McConnell: “Sebelius may be gone, but the problems with this law and the impact it’s having on our constituents aren’t. Obamacare has to go too.” As always, with McConnell, the law’s beneficiaries simply don’t exist.

Sargent nails it: 


[A]s enrollment continues to mount, Republicans are retreating to a fallback position, which is that Obamacare cannot work by definition. …

Last fall, as the law got underway and as the website then crashed, the Republican position was essentially that the law was fatally flawed (nobody wanted it, supposedly) and thus would inevitably fail to fulfill its own goals. Now that the law has hit enrollment targets, and evidence comes in that it is for now on track, the Republican position is that the law is a failure even if it is more or less doing what it was designed to do — cover a lot more people. Indeed, one way to describe the GOP position is that Republicans think the law is an inherent failure precisely because it is doing what it was designed to do.

The Republican position — that the law can’t work by definition – is essentially an admission that Republicans simply don’t support doing what Obamacare sets out to do: Expand coverage to the number of people the law hopes to cover, through a combination of increased government oversight over the health system and — yep — spending money. The GOP focus on only those being negatively impacted by the law, and the aggressive hyping of cancellations into “millions” of full blown “horror stories” – combined with the steadfast refusal to acknowledge the very existence of the law’s beneficiaries — is, at bottom, just another way to fudge the actual GOP position: Flat out opposition to doing what it takes to expand health care to lots and lots of people.

Sometimes Republicans are candid about this position, such as when Paul Ryan forthrightly admitted that once Obamacare is repealed, its popular provisions should not be restored because it would be too expensive. Others, however, recognize the political problem here, and continue to say they support Obamacare’s general goals while declining to detail how a replacement would accomplish them. The problem for Republicans is that they want to persuade folks that they, too, support these general goals — hence the perpetual promise of vague alternatives — but this posture is fundamentally incompatible with the idea that Obamacare cannot work by definition, because there’s no alternative way to accomplish those goals at the law’s scale.

I think Sargent’s points above are helpful context to keep in mind when folks cry foul if anyone points out the consequences of repealing Obamacare (lots and lots of people will lose coverage). 

Look, it’s perfectly reasonable for someone who opposes Obamacare to describe it as a bad law because they believe a large public investment in near-universal coverage is simply a bad idea. Or because they think don’t like the mechanisms by which Obamacare attempts to do that. But that’s really a very different question than whether the law is “working” as intended, or whether the law has “failed.” Republicans used to say that the law wasn’t going to achieve its goals. Now they’ve segued into saying that the law working as intended and achieving its goals is a bad thing. They weren’t concerned that it would fail, they were rooting for it to fail.

Last year, I had some candid conversations with Republican state legislators and other conservative politicos, well-informed folks who vehemently oppose Obamacare. When we would hash out our differences, one thing I would try to do is ground my claims and predictions into falsifiable territory. In other words, I thought that the health care law would, overall, “work” — but I could have been wrong (still might be!). I tried to establish what might go wrong, what things might signal that the law was not functioning as proponents hoped it would. My prediction was success, but I tried to define what failure might look like. Obviously, this is partly a matter of ideology, values, and prior beliefs, not a purely empirical question. But what sticks with me is how many of these folks told me with confidence that the law was doomed to collapse, was bound to fail even at what someone like me hoped it would achieve. 

And I would ask, what would count as success? What would prove you wrong? What would it look like if Obamacare ends up working after all? 


The most common response I heard: “It can’t.”