Matt Miller - The Archives
The Democrats' Midterm Nightmare
The Daily Beast, November 7, 2009
As House leaders push to pass health-care reform, a major political headache looms: The bill's impact won't be felt until long after already anxious voters go to the polls in 2010.

Democrats are in a predictable panic after this week's Republican conquest of statehouses in New Jersey and Virginia. But as the White House and congressional leaders look anxiously to 2010, they should realize their real problem is 2013. That's the year the new insurance exchanges being established by health reform would actually open for business, accompanied by hefty subsidies to help folks buy coverage.

Almost nobody in the real world (let alone in the chattering class) has focused on the 2013 dilemma. Yet the political implications are striking. Say the stars align and Obama is able to sign major health reform into law before he gives his State of the Union address in late January. What happens next? 2010 comes and goes. 2012 comes and goes. And then millions of Americans who lack secure health coverage start to get it, in Obama's second term. A recent poll by the Kaiser Family Foundation found that most Americans think they'll see tangible results from any health reform in the next year or so. This expectations gap is a looming disaster for Democrats.

Why the delay? One senior official involved in the launch of the Massachusetts insurance exchange—the model for national reform—tells me you need at least two years to get this kind of new regime up and running (Massachusetts did it in about 18 months, which this official says was not ideal). Add in the unsurprising fact that White House guru David Axelrod will never allow a potentially chaotic open enrollment in the new exchanges to take place in the run-up to the 2012 vote. So 2013 it is.

The Democratic midterm nightmare thus takes shape. The economy, though back from the brink, remains anemic in October 2010, with few new jobs and unemployment hovering at 10 percent. Meanwhile, the one big thing Democrats say they've done—the supposedly "historic" reform they trumpet on the stump—has delivered nothing tangible yet to voters. Instead, what voters in fact experience in 2010 is a continued rise in what they're paying for health care, via still-surging premiums and copays, as well as moves by employers to shift more of these costs to employees.

"Help is on the way" won't pack much punch as a Democratic argument in 2010—that only works when you're out of power. The likelier public sentiment, especially for critical independent voters who swung to the GOP in droves this week, is "This is what Democrats say they've accomplished?" The Republican ads write themselves. In recent days, Democratic euphoria at the prospect of major reform has been balanced by a growing awareness of this vulnerability. But the party's early response isn't convincing. Nancy Pelosi's office just put out a Letterman-style list of "Top 14 Provisions That Take Effect Immediately." It includes a temporary high-risk pool to help sicker folks who've been denied coverage elsewhere; a ban on lifetime caps on coverage; a way for children to stay on their parents' plans until age 27; and for displaced workers to keep their (very expensive) COBRA coverage until the exchanges open. It also features a $500 reduction in the "donut hole" for seniors' prescription-drug coverage, as well as discounts on branded drugs. This last measure should be meaningful for seniors. But it's pretty thin gruel for everyone else, relevant to relative handfuls of people. A hodge-podge like this may not add up to a potent message in the face of higher health costs and GOP attacks. For now, the White House seems to think that because these near-term measures poll well, they'll suffice. They shouldn't be so complacent. As the final sausage-making proceeds, Democrats need to fix their 2013 problem before it makes a hash of all they've worked for.