The news, an old saying goes, doesn’t cover successful airplane landings. But there’s one extremely notable successful landing happening right now, and unless you’ve gone to the inside pages of your newspaper, you might have missed it: open enrollment for the second year of the Affordable Care Act exchanges has begun, and in its first day, the federal exchange signed up 100,000 customers with only minor technical glitches.
Now try to remember what happened a year ago. Healthcare.gov was a mess, and there was an explosion of news coverage with reporters looking over the shoulders of frustrated consumers, while Republicans could barely contain their glee.
Add the success (so far) of open enrollment for next year to all the other good news about the ACA. We’ve had 10 million formerly uninsured Americans with coverage, lower than expected premium increases, a slowdown in health spending, customers happy with what they’ve gotten, a decline in uncompensated care, more insurers joining the exchanges. You’d think these facts on the ground would alter the political dynamics of this issue, especially since every one of those developments is precisely the opposite of what Republicans predicted would happen.
But of course, that hasn’t happened. So what would it take? What event or evidence would lead Republicans to finally say, “Okay, we’ll stop fighting Obamacare”? First, let’s look at some reasons why the ACA’s popularity has stayed so mediocre and Republicans have continued to find political utility in shaking their fists at it.
Bad news is newsier than good news. Everyone in America heard about healthcare.gov’s problems a year ago, but far fewer are going to hear about the successful rollout this year. The coverage of that first rollout was dreadful in many ways, but the simple fact is that bad news will always get more attention. So most Americans without personal experience this year will probably assume that the web site is still a mess and nothing works.
The health care system is so complex that few people understand how it works, let alone how the ACA, which is itself complex, interacts with that system. It was said in the early days after the law passed that now Barack Obama and the Democrats “own” the health care system, and we’ve certainly seen that play out. Republicans have successfully blamed every difficulty, frustration, and bad outcome anyone anywhere has had with health care on the ACA, and trying to explain to people why some problem they’re having with their insurer or their doctor isn’t actually Barack Obama’s fault is fruitless.
Republicans have become so ideologically and emotionally invested in opposition to the ACA that acknowledging its successes is impossible for them. Back in 2009 everyone understood that Republicans would oppose health care reform, but I don’t think anyone predicted that loathing of the ACA would become so central to conservative identity. Republicans can’t even bring themselves to acknowledge that there’s anything worthwhile in the law, to the point where GOP governors making the eminently rational decision to accept the law’s expansion of Medicaid will deny that the expansion actually has anything to do with the law that created it. Even acknowledging that the law is here to stay is utterly verboten among Republicans. Because people follow their leaders’ cues, approval of the law is unlikely to ever reach a majority, since nearly all Republicans will say they oppose it.
There’s no evidence that their denial of reality imposes any political cost on Republicans, which reduces their incentive to abandon that denial. It’s true that during the campaign, many Republican candidates changed how they talked about the law, dancing around the issue of full repeal and essentially promising to both drive a stake through its black heart and keep all the things about it that people like. But they never stopped saying that it was a disaster destroying America, because they never saw any reason not to. Even now, they find it perfectly comfortable to just deny that all the good news about the law’s implementation is actually true. So they’ll keep saying that it’s a catastrophe, and their supporters will believe them.
For the nearly five years since the Affordable Care Act passed, its supporters have optimistically kept their eyes fixed on a point at which the law’s positive effects will be widely felt, its popularity will rise, and the political threats to its existence will fade. This point always lies a few months or maybe a year in the future, when it will become impossible for anyone, even Republicans, to deny the facts on the ground. I’ll admit that in the early days after the law’s passage, I shared this optimism. But we know now that just won’t happen. So what will lead Republicans to finally move on from their opposition and go back to the place they were before on the health care issue, namely not caring about it much at all?
The answer lies in the term “Obamacare.” Hatred of the ACA is inextricably entwined with hatred of Barack Obama. When Obama leaves office in January 2017, the fire of that hatred will begin to cool. It won’t ever disappear completely, but it will lose its urgency, and, presuming the Supreme Court doesn’t gut the law (which could happen), it will increasingly become indistinguishable from the broader health care landscape.
Without Obama making Republicans newly angry each and every day, instead of everything in the health care system being Obamacare, it’ll just be the health care system, with strengths and weaknesses that might or might not require legislation to address. If you ask a Republican if he still wants to repeal Obamacare, he’ll say, “Of course.” But not many people will be asking.