America has been here before: The launch of a major new social policy. Critics on the right calling it a big-government job killer, socialism in disguise. Critics on the left calling it a big-business power grab, a flimsy attempt to help people on the bottom.
The year was 1935 — the pit of the Great Depression — and the policy was Social Security.
A popular new president, Franklin Roosevelt, pushed the act through Congress by depicting it as anti-poverty insurance for the elderly, as a strategy Europe had embraced and as a wise middle path between extremists.
On the left, social reformers such as Sen. Huey Long of Louisiana and radio preacher Father Charles Coughlin said America instead ought to rapidly put public money into the poor's hands.
On the right, critics predicted Social Security would “Sovietize America” and sap worker initiative. (The World-Herald's editorial writers at the time fretted about “the disappearance of the frontier spirit” of self-reliance.)
But of all the parallels between the Social Security Act of 1935 and the Affordable Care Act of 2010, one stands out: A wide consensus of policy makers who said, then and now, that any program so big and complicated requires adjustment along the way.
Social Security got its adjustments — and will need even more, its financial overseers say.
Will the Affordable Care Act get the tweaks it needs?
Three years into its phase-in, opponents are still trying to kill Obamacare, not fix it.
The Republican-run House has voted three dozen times to repeal it or gut it. The Senate, run by Democrats, won't even consider that.
Several GOP-led states have imposed rules making it harder for the federal government to recruit the “navigators” who are supposed to guide newcomers through the intricacies of health insurance. About half the states, including Nebraska, have refused to join in the law's expansion of Medicaid to cover more uninsured poor.
Given such a political climate, supporters of the law worry it'll be impossible to get Congress to make adjustments to the program. For instance:
>> Small businesses may need more tax credits to help them offer coverage, a change former President Bill Clinton recently urged. He also recommended fixing a glitch that prevents some workers who can't afford their employer's health plan from getting federal help to buy a plan on their own.
>> Critics say the law inadvertently created an incentive for big companies to cut employees' work hours below 30 per week, or to cut payrolls below 50 workers, the trigger levels at which insurance must be offered. In a way, President Obama already has tweaked this rule, called the “employer mandate,” by delaying it for a year.
>> Among other provisions that so far have gotten the tweak-by-delay treatment: a rule limiting the out-of-pocket costs patients must pay above what their insurance covers.
>> Sponsors of nonprofit health plans say they are unfairly denied federal subsidies like those that will help for-profit plans.
Even Obama acknowledges that the law tagged with his name will miss some original deadlines and need alterations as it plays out.
But no one expects changing its provisions — or even agreeing on which should be changed, or how — will be easy. Especially not as the 2014 campaign gears up and as contenders increasingly jockey to succeed Obama in 2016.