When up is down and down is up: the political paradoxes of Obamacare

Let me see if I’ve got this right:

The most implacable foes of Obamacare are alienating their allies and may inflict grave political damage on their own cause.

The most enthusiastic supporters of Obamacare are increasingly suspicious that some of its provisions may inflict serious economic harm on them.

The chief justice of the Supreme Court, whose vote “saved” Obamacare, may have fatally undermined one of its key provisions.

Some key Republican office holders, all of whom opposed Obamacare, may be in the process of salvaging it.

Most of the headlines these days around Obamacare — officially called the Affordable Care Act — focus on the political infighting that’s broken out on the right. With Texas Sen. Ted Cruz and Utah Sen. Mike Lee leading the charge, the most militant opponents of President Barack Obama's historic health care law are threatening to shut down the government, and perhaps trigger a disastrous default on the national debt, in a clearly futile effort to defund the law. This effort has led not only fellow GOP senators like John McCain and Tom Coburn to distance themselves, it has also drawn the scorn of the Wall Street Journal editorial page, usually an enthusiastic advocate of confrontation tactics. (Noting the political reality of a Democratic president and Senate, the Journal called the Cruz-Lee tactic a “charge into fixed bayonets.”)

This intraparty warfare, however, is only one part of the confusion Obamacare has triggered.

Organized labor, which has been fighting for some form of national health care for decades, has found enough problems in the new law to have expressed public dissatisfaction. Earlier this month, labor leaders met at the White House to demand changes to the law that, as currently written, could leave lower-income workers ineligible for subsidies that the law was supposed to provide.

Some labor leaders have even argued the law should be repealed if it can’t be fixed — the same demand usually heard from the most zealous of tea partyers.

Now remember the fury on the right and the relief on the left when Chief Justice John Roberts cast the deciding vote that upheld the constitutionality of Obamacare? Less noted at the time was that the Roberts opinion also struck down the requirement that states expand their Medicaid programs to ease the financial burden on lower-income people of Obamacare's insurance mandate. As a result, as a Politico column notes, millions of people will be required to bear the costs that this part of the law was supposed to cover.

So in the process of “saving” the Affordable Care Act, Roberts may also have gone a long way toward undermining it.

Finally, no group of office holders was more resistant to Obamacare than Republican governors. Now, with the law passed, signed and upheld in court, GOP chief executives from Florida to Ohio to Pennsylvania to Michigan to New Mexico to Nevada are working to establish health care exchanges, rather than leaving it to Washington to create those exchanges in their states.

"My approach is to not spend a lot of time complaining," Iowa Gov. Terry Branstad, a Republican, said last month. "We're going to do our level best to make it work as best we can."

With Republicans holding governors’ chairs in every big state outside of Illinois, New York and California, this approach could make the benefits of the new law more accessible to tens of millions.

Just in case all these political paradoxes don’t induce enough head-scratching, consider another possibility:

One of the fears of the Obamacare foes has been that, once the benefits started flowing, the citizenry would be so enthralled that it would be impossible to repeal the law. It is now at least possible to imagine the exact reverse: that delays, unintended consequences and bureaucratic snafus could make Obama’s signature domestic achievement a nightmare that haunts the rest of his presidency.