Republicans know that as time goes on, the constituency of new Affordable Care Act beneficiaries will grow, and eventually cross a point of no return past which "repeal," in the sense that they've been promising conservatives they will "repeal Obamacare," will become impossible. After all, Republicans are in the midst of proving how politically dangerous it is to pass laws that result in people losing their health insurance.
They understand the attraction of government benefits as well as anyone, which explains why they're attacking the law so aggressively in the early days of its enrollment period, before coverage kicks in on Jan. 1, and while its botched rollout is preventing hundreds of thousands of people from completing applications for insurance.
If the Obama administration manages to fix Healthcare.gov pretty quickly, then the story will change after the new year and Republicans will have to undertake an awkward political reversal.
At the same time, I don't think it's a stretch to say that in most of the country, the Affordable Care Act rollout has been a fiasco. It's probably the case, actually, that even if the errors get corrected quickly, the salient facts about the past month and the coming weeks -- the failure of the federally facilitated exchanges, the millions of cancellation notices -- will loom large over the program, particularly on the right, well into next year.
This will become a source of unusual tension in early January when it's time for Congress to fund the government once again. The ironic consequence of the October shutdown is that it suppressed the GOP's appetite for brinkmanship before the Affordable Care Act had been given a chance to make such a bad first impression.
It's unlikely that Republican leaders will allow rank-and-file conservatives to resuscitate the defund-or-shutdown strategy, per se. But the temptation will be enormous.
The GOP's dilemma will present Democrats an advantage above and beyond simply hoping that Republicans self-destruct again. They can use GOP leaders' aversion to shutting down the government again to ease the strain Republican intransigence has put on the part of the budget that facilitates Obamacare at the margin.
For the next five weeks, House and Senate negotiators will try to convene around a viable budget for the rest of the fiscal year. The "grand bargain" President Obama and House Speaker John Boehner twice pursued probably won't be struck. But it's easy enough to imagine Democrats and Republicans agreeing to cut some non-entitlement spending (farm subsidies, perhaps), raise some non-tax revenues (user fees and sales, for instance) and ply the savings into the discretionary budget. Pay down sequestration for a year or two and send agreeable allocations to congressional appropriators.
Many of the agencies in government that administer the Affordable Care Act receive their funding from the so-called "Labor-H" or "Labor-HHS" appropriations bill. For two years now, the Department of Health and Human Services has operated without a current budget. Congress has simply renewed its out-of-date budgets every time funding has expired. Then in March, HHS' antiquated budget had its wobbly legs cut out from underneath it when sequestration took effect.
If the budget negotiations succeed, Democrats should insist on a full-year appropriation for HHS, not just to smooth the rocky implementation of Obamacare but to restore funding to badly damaged programs and agencies like Head Start and the National Institutes of Health.
"It's a disaster. A disaster if we continue with the yearlong sequester and continuing resolution," said Sen. Tom Harkin, D-Iowa, who chairs the appropriations subcommittee with jurisdiction over the Labor-H bill, on the Senate floor during the shutdown.
Failing a full-year HHS budget, Democrats should insist on restoring HHS funding to its pre-sequestration levels. Put another way, they should refuse to let the GOP use the budget process to undermine Obamacare by shrinking the entire HHS budget by tens of billions of dollars -- by making the Centers for Disease Control and NIH and poor children collateral damage in their war against the Affordable Care Act.
The Democratic aides I've spoken with aren't laboring under an illusion that Republicans will be inclined to do Obamacare any favors in the coming budget negotiations. But they do believe that the October catastrophe convinced Republicans that the notion of shutting down the government -- or partially shutting down the government -- over the Affordable Care Act is an existential liability. Democrats should use that skittishness to their advantage. And if the ACA's early woes draw the GOP back into brinkmanship -- well, that'll be a problem for them to deal with.
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