By Henry J. Aaron, May 7, 2014
Open enrollment for 2014 insurance coverage under the Affordable Care Act (ACA) ended on March 31. When the White House reported that enrollment had reached the targets, one could almost hear sighs of relief from supporters and gnashing of teeth by opponents. In truth, meeting the enrollment targets made clear only that the administration had successfully brought order out of the chaos attending the rollout last October. After a ritually correct interval, Kathleen Sebelius, head of the cabinet department immediately responsible for that chaos, resigned.
Meeting numerical targets that were measured 6 months after the insurance exchanges opened will not determine the fate of the ACA. With time and administrative care, the ACA can and, I believe, will be implemented successfully. For the next several years, however, brutal political war, not objective measures, will determine the law’s fate. Over the longer term, the ACA’s success will depend on elected officials’ responses to the challenges that emerge as the U.S. health care system evolves.