The debate over the Affordable Care Act has entered a new stage, one that will challenge Republicans and Democrats alike. But the burden still falls more heavily on the Democrats to show that the law can become something other than a political weight on vulnerable incumbents this year.
With 7 million people now signed up under the health-care law, and more likely to join during future enrollment periods, the act is rapidly becoming embedded in the nation’s health-care system. Taking a victory lap on the day the administration announced its sign-up numbers, President Obama declared, “The Affordable Care Act is here to stay.”
The president asserted that the debate over repealing the law is now over. Republicans dissent, but there’s little question that the GOP’s goal of dismantling the law becomes increasingly difficult. For Obama and the Democrats, however, that also will mean that when problems arise in the health-care system, whether involving cost or coverage, critics will blame them — fairly or not — for the law’s complexity and the clumsy hand of government.
The substantive debate ahead will challenge Republicans most. Democrats contend that the progress that has been made in signing up so many people will force Republicans to temper their message of repeal and instead focus their energies on changes in the law. Outright repeal, they argue, is not only unrealistic, particularly as long as a Democrat is in the White House, but less and less appealing politically.
Republicans recognize that. They also know that, even if Obamacare isn’t terribly popular overall, many of its provisions are. Among the most popular are the provision that allows students to remain on their parents’ health-care plans until age 26 and the ban on denying coverage to people with preexisting conditions.
Demanding repeal of the act still generates enthusiasm within the Republican base, but the party leaders are far from a consensus on what they would substitute in place of existing law.
Gov. Bobby Jindal (R-La.) came forward with a plan last week that he said puts power back in the hands of individuals rather than government. Jindal knows the subject as well as any Republican, having held leadership positions in health-care agencies at the state and federal levels. But what he has in mind is hardly a simple change. He outlined its provisions at a breakfast with reporters hosted by the Christian Science Monitor. The more he described it, the more complex it sounded. It’s hardly a bumper sticker for the party.
Rep. Paul Ryan (R-Wis.), the chairman of the House Budget Committee, delivered his budget blueprint last week, which included a call to repeal the act. In an interview with Bloomberg News’s Al Hunt that will air on Bloomberg TV over the weekend, Ryan said he still believes the act will collapse under its own weight and said he and other Republicans are working on an alternative.
But according to The Washington Post’s Aaron Blake, Ryan raised questions about the cost of some of the law’s more popular provisions and suggested Republicans would try to find less expensive ways to accomplish the same goals.
Democrats are divided, as well, between those who essentially say stand pat with the act as it is and those who, for political reasons, are calling for changes to reduce the political liabilities they see in embracing the law completely.
Obama says he’s open to fixing the law’s problems but has proposed no real changes. He has acted unilaterally to postpone deadlines for implementation of specific provisions, which continues to infuriate Republicans. Administration officials claim the delays are simply for administrative reasons; Republicans see it as manipulation to avoid further political damage.
Politically, Democrats have adopted a message short of fully embracing the act. No, they say, it isn’t perfect. Changes could and should be made. This “mend it, don’t end it” message is increasingly popular among political strategists advising candidates in competitive races this year. Whether it’s anything more than a rhetorical ploy is a different question.
Five centrist Democrats — Sens. Mark Begich (Alaska), Mary Landrieu (La.), Mark R. Warner (Va.), Joe Manchin III (W.Va.) and Heidi Heitkamp (N.D.) — and independent Sen. Angus King (Maine) recently proposed changes designed to ease the impact on small businesses and individuals. They speak for the embattled wing of the Democratic Party, the red state Democrats who face difficult reelections. Democratic leaders, however, have shown no sign that they believe this is either good or necessary.
Rep. Debbie Wasserman Schultz (D-Fla.), who chairs the Democratic National Committee, did an interview with NBC’s Chuck Todd the day the administration announced it had reached the milestone in new sign-ups. She followed the party’s political playbook, acknowledging that the law isn’t perfect. If only Republicans would sit down with Democrats, she said, the two sides could deal with the law’s shortcomings. Todd then challenged her, asking what she would propose to change. She couldn’t come up with a single thing, proving that political rhetoric doesn’t equal policy.
For the past four years, Democrats have predicted that, with time, the popularity of the law would increase. So far, they’ve been proven wrong. What they and Republicans are closely watching now is whether that finally begins to happen.
A Washington Post-ABC News poll released last week showed that more people said they supported the act than said they opposed it (although by a single percentage point, 49 to 48 percent). Last November, at the height of the problems with the rollout, 40 percent said they supported it and 57 percent opposed it. By January, the split was 46 percent supporting, 49 percent opposed.
Most polls don’t show support as high as the new Post-ABC survey does. If future polls show something similar, Democrats will begin to breathe easier. The Post-ABC survey reflects increased support for the act among Democrats. Republicans and independents remain, on balance, opposed.
Democratic pollster Stan Greenberg argues that people are misreading the polls, that some of those opposed to the act believe it does not go far enough. Subtract them from the equation and the popularity of the law looks better. Be wary, he advises, of assuming that health care is a big problem for Democrats this year.
His analysis was based on the findings of a poll for National Public Radio that was designed by Democracy Corps, a Democratic firm, and Resurgent Republic, a Republican firm, and conducted by Greenberg Quinlan Rosner Research. Among other things, the survey found somewhat more support for the Democrats’ message than for the GOP’s.
But the law still energizes opponents more than supporters. In a year in which voter turnout could be decisive in key Senate races, motivation tips in the direction of the Republicans, which was underscored in the GOP analysis of the survey. “To counter Republican intensity and turnout in this off-year,” Greenberg wrote in an analysis, “Democrats will have to feel just as strongly about the risks of repeal and the loss of benefits.”
Whether Democrats can translate that into action will determine whether the politics of health care will shift by Election Day in November.