For Republicans, the Obamacare reckoning has arrived sooner than expected.
The politics of the health care law have undergone a sea change since its disastrous rollout last fall, when many conservative operatives were salivating at the prospect of a GOP wave in the midterm elections due to an Obamacare “train wreck.”
But the train never wrecked. The law rebounded, surpassing its signups goal and withstanding a flurry of attacks. The issue seems to have mostly lost its power as a weapon against Democrats, and a growing number of Republican governors — even in conservative states — are warming to a core component of Obamacare, the Medicaid expansion.
To get a sense of why this is worrying for Republicans in the long run, look no further than conservative strategist Bill Kristol’s 1993 memo — “Defeating President Clinton’s Health Care Proposal” — warning that reform would paint Democrats as “the generous protector of middle-class interests” and strike a “punishing blow” to the GOP’s anti-government ideology.
“But the long-term political effects of a successful Clinton health care bill will be even worse — much worse. It will relegitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government,” Kristol wrote.
In other words, the real fear back then was that health care reform would succeed.
Two decades later, Kristol’s prophecy is haunting Republicans. Obamacare has provided a lifeline by providing coverage to 8 million people on the exchanges, 7 million under Medicaid expansion and 5 million who bought insurance outside the exchanges but benefit from new regulations like the coverage guarantee for individuals with preexisting conditions. Even Republicans in deeply conservative states are suggesting that the popular new benefits cannot be taken away, even if the Obamacare brand still struggles.
The shift has been crystallized in contentious Senate races this fall. Senate Minority Leader Mitch McConnell (R-KY) recently signaled that Kentuckians benefiting from the state’s Obamacare exchange and Medicaid expansion should be able to keep their coverage. Senate GOP candidates Joni Ernst of Iowa, Tom Cotton of Arkansas, Scott Brown of New Hampshire and Terri Lynn Land of Michigan have all refused to call for rolling back Medicaid expansion in their states. The number of television ads attacking the law have plummeted in key battleground states since April, and now even vulnerable Democratic Sen. Mark Pryor of Arkansas is touting his vote for protecting Americans with preexisting conditions under Obamacare.
But even if the Obamacare attacks are fading, Republicans remain poised to make gains in the midterms due to a variety of structural advantages. They continue to oppose Obamacare as a whole, and point out that Americans still react negatively when asked about the law.
“Ensuring that people with preexisting conditions have access to coverage has long been a popular policy, and one where there is bipartisan agreement. It’s the the entirety of ObamaCare that remains EXTREMELY unpopular,” Brad Dayspring, a spokesman for the Senate GOP’s campaign arm, told TPM in an email.
Conservative health-policy experts have argued that Obamacare cannot be repealed without a viable alternative to fix broken parts of the system, but Republicans have failed to come up with one that the party can unite behind.
These are signs that Obamacare is weaving into the fabric of American culture and that the dream of repealing or unwinding it is fading. The massive health care industry is adapting to the post-Obamacare world and fears of double-digit hikes in premiums are fading: early data suggest the prices for benchmark “silver” plans in 2015 are poised to decline slightly.
“We don’t yet have data for all states, but from these 15 states plus DC I think we can start to see a pattern emerging,” Larry Levitt, senior vice president at the Kaiser Family Foundation, said in an email. “In general, changes in premiums for the low-cost plans in the marketplaces are quite modest, and actually decreasing in many places.”
Stability in premiums means “government costs for premium subsidies … are under control, which is good news for taxpayers,” Levitt said.
In the courts, an ongoing conservative lawsuit to cripple Obamacare suffered a major setback last week when a federal appeals court vacated a ruling that would have blocked subsidies in 36 states. Legal experts say the full court is likely to uphold the subsidies when a panel with a majority of Democratic-appointed judges re-hears the case.
For Democrats, the dream scenario was that Obamacare would eventually join Social Security and Medicare as an unassailable feature of the American safety net. Like those other major programs, Obamacare won’t be without its share of problems — cost uncertainties for automatically-renewed plans among them. But after more than 50 House votes to repeal or dismantle the law, few could have predicted that Republicans would start warming up to central pieces of the law within a year of its rollout.
(Photos by the Associated Press)