In it, but not of it. TPM DC
The Republican Senate minority leader is rhetorically standing by his pro-repeal stance, but -- in what amounts to a softening of his position and a contradiction -- he's also saying his home state of Kentucky should be allowed to keep Kynect, its state-based Obamacare exchange, if the federal law is eliminated.
"If Obamacare is repealed, Kentucky should decide for itself whether to keep Kynect or set up a different marketplace," Allison Moore, a campaign spokeswoman for McConnell, told TPM in a statement Tuesday. "But Kentuckians shouldn't have been forced to lose the plans they had and liked, shouldn't have seen their premiums skyrocket, shouldn't have had their Medicare cut, and shouldn't have had their taxes raised because of President Obama and his friends in Washington forced it down their throats."
His campaign added that Kynect creates a "marketplace of private insurance plans" and states like Utah and Massachusetts had established similar systems before Obamacare became law in 2010. His campaign stayed neutral on whether Kentucky should reconstitute Kynect if Obamacare is repealed.
The Senate GOP leader's remarks follow a report Friday when McConnell, in a move that raised eyebrows, told home state reporters that the fate of Kynect was "unconnected" to the fate of Obamacare. His campaign's statement Tuesday suggests he's standing by that position.
It's unclear how McConnell's idea might work -- or if it can work. Kynect relies upon Obamacare and would not have existed without it. The federal health care law funds the subsidies it doles out to help Kentuckians buy insurance; it establishes the regulations that protect residents with preexisting conditions; it imposes the individual mandate to entice younger people into the system in order to prevent a cycle of price spikes. If Obamacare is repealed, all these features collapse and Kynect crumbles.
Jon Gruber, an MIT professor who helped craft Obamacare, said state-run exchanges could exist without the federal law but warned that they'd be toothless without similar features.
"An exchange could exist without Obamacare -- but it would be largely irrelevant," Gruber said. "A number of states tried to set up group purchasing arrangements and related approaches pre-Obamacare and they by and large failed. Without tax credits and the mandate, there is little demand for the exchange -- and it does relatively little for the market."
Politically, the implications of McConnell's softening position are vast, considering his leadership role in keeping the GOP united against Obamacare and taking no prisoners in his ruthless crusade to repeal it "root and branch," as he has repeatedly said. It signals a realization that Obamacare is, at the very least, creating enough winners that repealing it without replacing it with something similar is untenable. Kynect in particular has been more successful than most state marketplaces, cutting the state's uninsured rate by at least 40 percent.
McConnell's remarks also signal to other Republican senators and candidates that it's acceptable to take wishy-washy positions on Obamacare, perhaps for the sake of warding off Democratic attacks about wanting to strip away health coverage for millions of newly insured Americans. Notably, the comments come toward the end of Republican primary season (McConnell easily defeated his conservative challenger Matt Bevin last Tuesday), when the party is turning its attention to winning over swing voters who, as a variety of recent surveys show, don't necessarily like Obamacare but also don't want to repeal it.
Republicans have also backed themselves into a corner by hammering Obamacare for canceling millions of policies that didn't comply with the law's minimum coverage standards. Now that Obamacare itself has covered millions of Americans since its exchanges went live on Oct. 1, 2013, they cannot call for taking away that coverage without political repercussions. Apart from the state-run exchanges, Obamacare also offers millions of dollars for states to cover more residents under Medicaid, a feature of the law that McConnell has opposed but which numerous Republican governors have embraced.
Democrats, of course, have had their own problems with Obamacare since the disastrous rollout of the online federal exchange. Numerous Democratic incumbents have called for dramatic changes that would weaken the law while red state Senate candidates like Kentucky's Alison Lundergan Grimes and Georgia's Michelle Nunn refuse to say if they would have voted for passage of the Affordable Care Act in 2010.
McConnell, however, has never wavered on Obamacare, and his doing so now signals that the game could be over for the repeal coalition.