That said, it has proved difficult — to put it mildly — to expand coverage to poor people in states that reject the law. Some states may well follow New Hampshire’s lead, reversing their initial opposition to the expansion of Medicaid.
But if the federal government’s current strategy of exemptions and semantic dodges proves unequal to the task of gaining Obamacare purchase in states such as Texas or North Carolina, its architects will need to look for an alternative. Spending $1.3 trillion in health-care subsidies for the middle class while leaving many poorer Americans with no options threatens the moral basis for the whole undertaking.
There’ll be time enough for that debate. The Affordable Care Act isn’t a gambit that wins or loses — certainly not yet. It’s a long-term and complicated response to a longer-term and more complicated problem, the solution to which cannot be found through the tiresome debate about Obamacare’s numbers.