When it comes to his health care law, President Barack Obama faces a political version of what insurance folks call "adverse selection": All the bad news is sticking to him and most of the good news is sticking to someone else.
Adverse selection, as we've been hearing lately, is what happens when a health insurance plan attracts too many sick people and not enough healthy ones. The plan's costs go up, its rates rise, healthy people drop out and, before you know it, you're in what actuaries call a death spiral.
Obama isn't at that point yet. But the self-inflicted damage he has suffered in the past month is serious and likely to be enduring.
For most of his time in office since 2009, polls found that although most Americans didn't fully agree with Obama's positions on national issues — a majority considered him more liberal than they were — they liked and trusted him. When it came to whether Obama was honest, strong and looking out for the interests of ordinary people, the president's scores were healthy.
No longer. In an ABC News-Washington Post poll released Tuesday, for example, Obama fell into negative territory on those three crucial measures. And that's a problem.
A president who scores well on those attributes — as Obama always had — gets the benefit of voters' doubts when he stumbles. A president who falls short on those qualities risks being blamed for anything that goes wrong.
That means that when insurance policies get canceled, rates rise or insurers refuse to reinstate old policies, more people will be ready to blame Obama for those failings without giving him credit for what's working.
And that's unfortunate for the president because some things are, in fact, working. In Kentucky, Connecticut, Washington, New York and California, state-run health insurance marketplaces are enrolling buyers by the thousands. But once a president loses voters' confidence in his honesty, they aren't likely to see his achievements in the same light.
Instead, the governors and insurance commissioners will get credit for any successes, and they'll deserve it. The president will still be wrestling with a balky federal marketplace — and suffering by comparison. It may look as if Obamacare can work but only when Obama himself isn't running it.
The problems won't end once the federal marketplace struggles to its feet either. From now until well into next year, every individual story of someone dissatisfied with their insurance choices will serve as a renewed reminder that Obama made promises that weren't true.
Things could get even worse if the president is unable to keep another of his promises: that the federal government's Healthcare.gov website will be working well by Nov. 30.
Already, the president has begun trying to redefine success downward on that goal. "The website will work much better on Nov. 30 than it worked certainly on Oct. 1," he said last week. But he'll have trouble convincing anyone that a marginally better website fulfills his pledge.
And next year, when the new insurance policies are up and running, the president will face another gap between his rhetoric and reality. "No matter how we reform health care," he said in 2009, "we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period."