By Charles Pierce, Esquire

There were three less-acknowledged, and obviously weaker, intellectual pillars supporting the Affordable Care Act. One was that republican governors would accept the Medicaid expansion because, free money! We have seen how well that worked out. The others were that a) insurance companies would cease being heedlessly greedy bastards in return for a few million new customers, and b) that there were enough Democratic legislators capable of standing up against a strong breeze to have the president’s back against what promised to be a powerful political backlash. We discover today that both of these pillars have cracked very badly.

At a news conference in mid-November, an apologetic Obama relented to the criticism, announcing that the federal government would let insurance companies continue for another year to offer individuals and small businesses health plans that do not meet the new requirements. The decision, however , is up to each state’s insurance regulator, and not all have gone along. This second change, prompted by a group of Democratic senators – most of whom face tough reelection campaigns next year – goes substantially further in accommodating people upset about losing their policies. The latest rule will allow consumers with a canceled health plan to claim a “hardship exemption” if they think the plans sold through new federal and state marketplaces are too expensive.
Mark Warner and Tim Kaine may survive as senators now — although please tell me that they’re not children enough to believe that they won’t be beaten over the head with “OBAMANAZICARE!” for the next year anyway — but Ezra Klein does a good job describing how perilous this concession may be to the survival of the law itself.

But this puts the administration on some very difficult-to-defend ground. Normally, the individual mandate applies to anyone who can purchase qualifying insurance for less than 8 percent of their income. Either that threshold is right or it’s wrong. But it’s hard to argue that it’s right for the currently uninsured but wrong for people whose plans were canceled.
Very hard.

All of the other fixes so far have been a sideshow, even though they have been used to gin up the meme that the law already has failed. However, the individual mandate is the ballgame. Without it, the law cannot work. We knew that in Massachusetts when our health-care reform went through. (Thanks, Willard!) But I think this passage from Klein’s analysis bears closer scrutiny, if only for the sheer ballsiness of its assertions.

The insurers aren’t happy. “This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers,” says Karen Ignani, head of the trade group America’s Health Insurance Plans. They worry the White House is underestimating the number of people whose plans have been canceled and who will opt to either remain uninsured or buy catastrophic insurance rather than more comprehensive coverage.
I’d like to know from Ms. Ignani how many of the members of her trade group, for the purposes of maintaining high profit margins, simply cancelled people rather than make the insurance plans currently held by those people compliant with the new law. In any case, a whole new element of risk has been injected into the debate at a time when the law desperately needs to be seen as less of a gamble.