It’s not going to be the best possible system, and there will be hiccups when employers start telling people to go to the exchanges (not that their plans will get worse, but just that people hate change), but it’s going to work.
Or else why would the Republicans care so much? I mean, they made the Dems pass it on a party line vote. If it doesn’t work, the Dems will get destroyed in 2016 and the evil fascist/communist/whatever law will get repealed.
But if it does work, it’s going to do permanent damage to the GOP and their theory of the world. This is why the famous Bill Kristol memo of the HillaryCare era was so telling. At least Kristol was honest. They knew it would completely reverse the Goldwater-Reagan-Gingrich-Teaparty anti-New Deal revanchism that is the core of their being.
What’s going to make it worse for them is that by letting states vary how it works, some states are going to do it better. Vermont will have single payer, for example. California and New York appear to be set for huge savings. States that are just trying to sabotage the system are going to look stupid next to those where it succeeds.
Also, eventually, some enterprising state will put a public plan on the market that rivals the private plans. Maybe California. And it should automatically be about 20% less than the private companies who are allowed by law to get a 20% “non-medical” expense ratio. (Medicare is about 3%). Even if that works out to about 10% less for the state platinum plan, it would still put pressure on prices.
And what’s ironic is that this is the conservative think tank, “market-based,” Romneycare model.