Obama signs Affordable Care Act

President Obama signs the Health Care and Education Reconciliation Act of 2010.

There is growing concern that a problematic implementation of the Affordable Care Act will hurt Democrats in 2014. In response, some on the left, like Jonathan Cohn, have pointed to Medicare Part D as an example why such concerns are overblown. They argue while the implementation of the drug benefit program was rocky, it was not a big political issue in the next election and quickly became popular.

There is one very important difference between Part D and the ACA that makes this a poor analogy. There were no “losers” during the implementation of Medicare Part D. While done in a needlessly complex and wasteful manner Part D was purely a benefit expansion. It just give senior drug coverage which was mostly a plus for seniors, drug companies, insurance companies, and pharmacies. Since it wasn’t paid for there were no direct losers, except the national deficit.

On the other hand, the implementation of Obamacare was designed to feature a mix of winners and losers. Low income people who qualify for Medicaid will be clear winners, yet many other people will see themselves as worse off because of the law. Certain middle income people who buy their own insurance could see big premium increases. Some business owners will be hit with a significant penalty for not providing insurance, while some workers might see their hours cut to avoid this penalty. Parts of the health care industry will also face new taxes.

The fact that there will be a significant number of clear “losers” that can be repeatedly highlighted should makes for a very different politics come 2014.