It hasn't been a good week for the Affordable Care Act. After announcements by the administration of several delays of key portions of the law, Republicans returned to Capitol Hill and began piling on.
"This law is literally just unraveling before our eyes," said Rep. Paul Ryan, R-Wis., at a hearing of the House Ways and Means Committee. "I don't know how you can conclude that this is not a total fiasco."
But this isn't the first time a major health law has gotten off to a rocky start.
In the beginning, things didn't look so good for the now very successful Medicare prescription drug law, either. "About this time in 2005, the percentage of people who had an unfavorable opinion of the law was actually higher than those who had a favorable opinion," says Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute. "So there was a lot of uncertainty and a lot of questions about whether this program was a good idea."
Corlette, who recently co-authored a paper on the lessons learned from the implementation of the Medicare drug law, says many of the same complaints being made about the Affordable Care Act today were also made about the Medicare drug program then. The Medicare invited private insurance plans to compete to offer prescription drug coverage to seniors and the disabled.
"A lot of folks really questioned the design of the program," she said. "They thought it was going to cost way too much; there were a lot of concerns about it."
Many of those concerns, of course, were coming from Democrats. They were infuriated that Republicans were getting credit for adding a drug benefit, known as Medicare Part D. The Democrats weren't anywhere near as vitriolic about the Medicare plan as Republicans have been about the health law, but there was still quite a partisan tenor to the complaints, remembers Mike Leavitt, who was secretary of health and human services at the time.
"There is always a political backdrop to the implementation of a controversial law," said Leavitt in an interview. "With Part D, clearly the Democrats did not believe this would succeed, and I think in their heart didn't want it to succeed. I suspect the inverse is true in the context of this [Affordable Care Act] law."
And if you think the Republicans have been critical of the Obama administration's efforts to promote the Affordable Care Act, you might not remember the howls from Democrats about the Bush administration's promotional efforts for the Medicare drug expansion.
Those mostly involved a nationwide bus tour that featured top administration officials as well as representatives of private companies.
"I went to 119 cities myself," Leavitt recalled at a recent event at the Brookings Institution. "I'm sorry — 98 cities and did 119 events. The bus traveled over 600,000 miles; we had 50,000 events that we ultimately orchestrated."
Yet perhaps the most memorable part of the rollout of the Medicare drug law was when it first went live, on New Year's Day in 2006. Things didn't go particularly well. Computers couldn't talk to each other properly. Seniors ended up on endless phone holds. It took several months to work out many of the kinks.
This time, Gary Cohen is overseeing the implementation of the health law for the Department of Health and Human Services. He said at the Brookings session that he and his staff learned a lot of important lessons from the Medicare drug law experience.
"Oct. 2, it's all hands on deck," he said, referring to the day after the health exchanges open for people to start signing up.
Cohen said he and his staff will "be prepared for the fact that things aren't going to be absolutely perfect right out of the gate. And I think we're trying to communicate that; to make sure that people understand that this is big; it is complicated, but over the course of time we will get there and we are mobilized to try to address whatever issues will come up."
Which is eventually what happened with the Medicare drug law.
"Eight years later it's inconceivable that we wouldn't have a Medicare drug benefit," says Georgetown's Corlette. "It's an enormously popular program, no matter what your political persuasion."
All of which hardly guarantees a similar success for the health law. But the history of not just the Medicare drug law but Medicare itself has shown that less-than-smooth launches haven't necessarily signaled a failure to follow.