The Affordable Care Act is Dead
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Liberals have thought themselves awfully clever this past week following a segment on Jimmy Kimmel’s talk show in which he asked people what they thought of both “Obamacare” and the “Affordable Care Act.” Turns out respondents hated Obamacare but were far more keen on the ACA. This is being touted as evidence that it’s not the president’s signature health care law that’s unpopular—merely the stigmatized word “Obamacare.” An NPR editor even wrote to his staff, discouraging them from using the O.C.-word.

So is it all just problem of semantics? Is it time to change the way we talk about health reform? Peggy Noonan has an excellent thought at the end of her column today:

OK, the Affordable Care Act doesn’t exist anymore. It was passed and adjudicated, but since then it has changed, and something new taken its place. Hundreds of waivers and exceptions have been granted. The president decided he had the power to delay the participation of businesses, while insisting on the continued participation of individuals. The program debuted and the debut was a disaster and Americans who want to be part of it haven’t been able to join.

The ACA doesn’t exist anymore. It isn’t the poor piece of legislation it was, it’s a new and different poor piece of legislation.

In fact, I’d take it a step further. It’s the old philosophical dichotomy of potentiality vs. actuality. The Affordable Care Act was what high-minded liberals imagined health care reform to be in potential—universal coverage, deficit-neutral, bending the cost curve downwards—and what some of its more delusional defenders still imagine it looks like. Obamacare is what health care reform is in actuality—downgraded coverage expectations, running up the deficit, bending the cost curve upwards, half the deadlines missed, carving up the full-time job market, higher premiums, sticker shock, exchange websites that don’t work, higher taxes, bureaucracy, cluelessness. This is what Americans rightly despise, even if the Obamacare/ACA distinction causes confusion.

The Affordable Care Act was always going to change into something different. It gives the bureaucracy wide latitude with regards to implementation, containing 900 mentions that Kathleen Sebelius “shall” or “may” do something, and another 139 references to things she “determines.” The current product fills in those gaps with failure, dashed expectations, and broken promises.

And there’s only one word to describe that: Obamacare.

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