The Washington PostDemocracy Dies in Darkness

Can Dems win on the Medicaid expansion?

The big Washington Post piece reporting on poor Kentucky residents now gaining access to health care under the Affordable Care Act continues to resonate today. Markos Moulitsas highlights the case of Ronald Hudson, a 35-year-old man with high medical bills who had this to say, after learning he would now be covered under the Medicaid expansion:

“Well, thank God,” Hudson said, laughing. “I believe I’m going to be a Democrat.”

Which raises a question: Despite Obamacare’s unpopularity, can Dems nonetheless campaign aggressively on the Medicaid expansion, on the theory that the more people get covered, the harder it will be to take coverage away from them?

As Moulitsas put it: “A rural southern white male is openly talking about becoming a Democrat. Why? Because Democrats have now made his life a little better…Hudson will have a stark choice in 2014: Vote for Mitch McConnell, who wants to take away his health security just as he finally gets it, or for Alison Lundergan Grimes, who won’t.”

This is not a slam dunk issue for Republicans. At a press conference in Kentucky earlier this month, Mitch McConnell was pressed on the Medicaid expansion — which is responsible for 85 percent of new signups in Kentucky — and on the benefits the law will extend to people. He didn’t have a very good answer. The Courier-Journal reported it this way:

McConnell took umbrage at the argument that the numbers in Kentucky add up to a successful program.
“Well look, if I went out here on the street today [and said], ‘You guys want free health care?’ I expect you’d have a lot of signups,” he said. “People signing up for something that is free” is the only thing about Obamacare in Kentucky that could be considered successful.
Asked more than once what parts of Obamacare, if any, were beneficial to the millions of people in the country without health care, McConnell had only one answer, stating repeatedly: “The law should be repealed.”

McConnell’s answer: Resort to a variation of Mitt Romney’s “free stuff” argument, and to avoid direct questions about the benefits of the law for millions.

If the law works over time, this could only get harder for Republicans. And this is the other side of the big argument over those losing their coverage and seeing premiums rise. Republicans are absolutely certain this development is already a huge winner for them. But as Brian Beutler notes, a new Families USA study finds that over 70 percent of those on the individual market who are under 65 will become eligible for financial help getting other coverage, whether through subsidies or through the Medicaid expansion.

If the website gets fixed, Democrats will be helping those people get coverage, and in many cases they may find they like it better. Meanwhile, Republicans will be faced with a choice between continued Total War against the law, including the Medicaid expansion, and the “moral imperative they face to direct these constituents toward new options.” Worse, Republicans will continue to face pressure from the right not to accommodate the Medicaid expansion, an issue that is already dividing GOP governors and even emerging as an issue in GOP primaries.

Will Dems campaign aggressively on the Medicaid expansion? For them, the politics of the issue may well turn on how it’s framed. Polls show that majorities of Americans think the health law will help poor people and those without insurance, but not that it will help them or the country overall. Dems may well worry that if the Medicaid expansion gets framed solely as expanding a government program for the poor — the handout that McConnell describes — it could put them at risk. Dems will probably emphasize that the expansion is sound budgetary policy, arguing that it makes sense for states to accept huge amounts of federal money.  (Terry McAuliffe won in the purple state of Virginia while emphasizing both of those framings.)

At first red state Dems may shy away from the Medicaid expansion a bit. But ultimately, if Obamacare works over time, Republicans may be the ones who are really left struggling to explain their stance on it.