In it, but not of it. TPM DC
With the law benefiting many voters in their states, Republican candidates in key Senate races are tacitly supporting core Obamacare provisions, most notably the Medicaid expansion.
But shhh, don't call it Obamacare. "Obamacare" remains a dirty word in Republican politics, and so these candidates are rhetorically toeing the party line for repeal. Scratch beneath the surface and they're making a logically strained implication that they can eliminate Obamacare without taking away its benefits.
One revealing example is North Carolina Republican Thom Tillis. During the primary, the state house speaker boasted in a TV ad that he "stopped Obama's Medicaid expansion cold." But last week he flipped his position and argued that North Carolina is "trending in a direction where we should consider potential expansion." He told Time Warner Cable News, "I would encourage the state legislature and the governor to consider it."
North Carolina GOP Senate candidate Thom Tillis. (AP Photo/Gerry Broome)
Medicaid expansion isn't a small piece of Obamacare, it accounts for about half of the law's newly insured non-elderly adults: 8.7 million more Americans have enrolled under Medicaid or the Children's Health Care Program since the expansion last year, compared to 7.3 million on the Obamacare exchanges, according to administration figures. (Millions more young adults under 27 have gained coverage under a parent's policy due to Obamacare regulations.)
Iowa's Joni Ernst, who holds a narrow lead in the race, illustrates the dilemma for Republican Senate candidates caught between a conservative base that despises Obamacare and their constituents who are benefiting from the Medicaid expansion — an estimated 100,000 Iowans. Ernst has repeatedly called for repealing Obamacare, but she has also said Congress must "protect those that are on Medicaid now."
Republican U.S. Senate candidate Joni Ernst. (AP Photo/Nati Harnik)
The two positions are difficult to reconcile. If Obamacare is repealed, Medicaid would lose its authority to spend federal dollars to insure those additional Iowans, and they'd be thrown off their coverage. Ernst's campaign hasn't responded to three queries by TPM since late August on how she would maintain existing Medicaid coverage if Obamacare is repealed.
The party-wide shift is occurring quietly and under the surface, but it's a pivotal moment for Obamacare, a sign that the law is enmeshing into the fabric of the health care system as the politics of repeal change. It also raises important questions about whether Republicans would have the political will to repeal Obamacare if they gain the power to do so.
Senate Minority Leader Mitch McConnell during a Kentucky Senate debate.
The dilemma has vexed Senate Minority Leader Mitch McConnell of Kentucky, where the state-based Obamacare portal, Kynect, has signed up some 520,000 residents under Medicaid expansion and the subsidized market exchanges. What's the Republican leader to do? Throw them off? That's too risky, especially when he's facing an unexpectedly strong reelection challenge from a Democrat who promises to protect that coverage.
McConnell has sought to distinguish Kynect from Obamacare, arguing that Kentucky should be allowed to keep Kynect if Obamacare is repealed, and saying Kynect is merely a "website" that he's "fine" with continuing. His position on the health care law was pilloried as "bizarre" by the Louisville Courier-Journal and an "outlandish deception" by the Lexington Herald-Leader, the state's two largest papers.
Asked what Obamacare repeal would mean for the newly covered Kentuckians, a McConnell Senate aide gave TPM a statement from the senator calling for "repeal and replace" of Obamacare "with commonsense patient-centered reforms that preserve greater choice for my constituents while also lowering costs." It's unclear where that would leave the Kentuckians who are insured because of Obamacare subsidies and Medicaid expansion.
Former Massachusetts U.S. Senator Scott Brown (AP Photo/Jim Cole)
In New Hampshire, Republican candidate Scott Brown is supporting Obamacare's popular provisions while calling for repeal of the unpopular taxes that fund the law and the mandates that make it economically sustainable.
"We have the ability to develop a plan that addresses ... [Medicaid expansion], preexisting care, covering kids to a certain age, dealing with catastrophic care and coverage, all sorts of things. We can develop a plan that works for us," Brown said at a debate last week. He didn't get more specific about how these provisions would be reconstructed or financed.
Republican Congressman Tom Cotton (AP Photo/Danny Johnston)
In the south, Republican congressman and Senate candidates Tom Cotton of Arkansas and Bill Cassidy of Louisiana — both of whom lead their Democratic rivals in the polls — have gone silent on the issue of Medicaid expansion.
Cotton has refrained from acknowledging that rolling back his state's private-public hybrid version of the Medicaid expansion would throw thousands of Arkansans off their coverage, even though his call for a McConnell-style root-and-branch repeal of Obamacare would do that. Cassidy has held his fire against Sen. Mary Landrieu (D-LA) on Medicaid expansion, which Louisiana has not adopted but which she has prominently supported.
Ohio Gov. John Kasich, a Republican who is coasting to reelection, spoke candidly about the politics of Obamacare last week, saying repeal is "not gonna happen." He said Republican governors who declined to expand Medicaid were doing so for the wrong reasons. "The opposition to it was really either political or ideological," he told the Associated Press. "I don't think that holds water against real flesh and blood, and real improvements in people's lives."
Ohio Gov. John Kasich (AP Photo/Mark Duncan)
As Kasich learned the hard way, the conservative base isn't ready to accept this. The pushback was fierce, and the governor backtracked in a matter of hours, making the strange argument that Medicaid expansion is not actually "connected" to Obamacare. Ironically, the governor found himself defending the single-payer component of Obamacare while objecting to the coverage expansion on the private insurance market.
Republicans in competitive races are approaching Obamacare with a similarly cautious attitude. Pay lip-service to repeal without defending its implications for beneficiaries, and perhaps support the popular parts of the law. That's hardly a basis for claiming a mandate to wipe the law off the books if they win control of the Senate, which is a very real possibility next week.