The Washington PostDemocracy Dies in Darkness

Opinion Republicans are losing the argument over Obamacare repeal. Can that save it?

So much winning! (AP Photo/Evan Vucci)


I continue to believe that repeal of large chunks of the Affordable Care Act remains likely to happen within the next few weeks or months. But that doesn’t mean Republicans are winning the public argument over it. Indeed, the most likely outcome at this point is that Republicans end up forging ahead with repeal even though the politics of it have shifted against them.

A number of new data points this morning suggest that this is what is in the process of taking place. First, Mike DeBonis reports that congressional Republicans are shying away from holding town hall meetings, possibly because they fear that public blowback from constituents worried over repeal will create precisely the sort of bad optics that hit Democrats amid the Tea Party summer of 2009:

Seven years after unruly Democratic town halls helped stoke public outrage over the Affordable Care Act, Republicans now appear keen to avoid the kind of dustups capable of racking up millions of views on YouTube and ending up in a 2018 campaign commercial. One week after the Republican Congress kicked off the process of repealing the landmark health-care legislation, only a handful of GOP lawmakers have held or are currently planning to host in-person town hall meetings open to all comers — the sort of large-scale events that helped feed the original Obamacare backlash in the summer of 2009….
That may be because such freewheeling events — especially with a hot topic like the ACA on the table — can devolve into chaos, with made-for-social-media moments brought to you by anyone with a smartphone in the audience….Since Congress took its first steps to unwind the ACA, Republicans have been publicly confronted by constituents — generating media reports and shareable videos that have been happily circulated by Democrats eager to turn the tables on the GOP.

As the piece details, a number of specific viral moments have already taken place involving people either upset about losing Obamacare, or, in one case, a man flatly claiming it saved his life. All of this is pretty unexpected. Wasn’t repeal supposed to be primarily greeted with a great outpouring of tearful public relief and catharsis over the glorious moment of liberation that is finally at hand after many long years of darkness and oppression?

A week before President-elect Trump's inauguration, lawmakers passed a preliminary budget measure that starts the process of repealing the Affordable Care Act. (Video: Sarah Parnass/The Washington Post, Photo: Matt McClain/The Washington Post)

Most signs suggest that, as repeal looms as a reality, the terms of the debate are, if anything, shifting in favor of the law. One obvious tell is that Trump and his advisers continue to be almost comically cagey about the intentions for their replace plan. Trump and his political team continue to suggest that everybody will be covered under it, even as his own pick for health and human services secretary, Tom Price, plays semantic games designed to obscure whether this is really so. Other Republicans have employed all sorts of tortured talking points designed to shroud their true long-term intentions in impenetrable rhetorical fog. The bottom line is that Trump and Republicans appear deeply reluctant to associate themselves with an outcome in which lots of people would in fact end up losing coverage.

Here’s more: The Associated Press reports that GOP governors from states that expanded Medicaid “are adamant that Congress maintain the financing that has allowed them to add millions of low-income people to the health insurance rolls.” In other words, GOP governors still want the money that the Medicaid expansion has brought in to expand coverage to their constituents. The GOP replace plan would almost certainly roll back the Medicaid expansion, which might be replaced by some form of block-granting of Medicaid money to the states — an outcome GOP governors surely would like, since it would give them more implementation flexibility. But block-grants could mean cuts over time that leave fewer people covered. Their desire to avoid losing this money could figure into the debate over what a replacement might look like — and here again, Republicans don’t appear to want to be associated with an outcome that actually ends up knocking people off coverage. Remember, more than 20 GOP Senators come from states that expanded Medicaid.

The point here is not that these shifting politics will prevent ACA repeal. It still remains plausible or likely that Republicans will succeed, via a simple majority “reconciliation” process, in rolling back the Medicaid expansion and the subsidies that helped expand coverage. Rather, the point is that these shifting politics could matter to the debate over what comes next. Democrats hope that the fear of an outcome in which millions lose coverage — combined with the GOP need for some Dem votes to pass a replacement — will give them leverage to compel Republicans to embrace a replacement that does not represent a major backslide in human welfare.

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Republicans still have all sorts of political tricks at their disposal. Repealing Obamacare on a delay could unleash turmoil in the insurance markets. This, plus any Trump administration executive actions that undermine the law, could create an atmosphere of chaos that Republicans can blame on Democrats, weakening their position in the coming replace battle. As Brian Beutler explains, Democrats need to prepare for this possibility now by “credibly establishing that Republicans are undermining the market through dithering and sabotage.” They also need to continue credibly establishing that the massive looming loss of coverage is rooted not in Obamacare’s supposed inevitable long-term collapse, as Republicans will argue, but rather in a simple fact: Republicans just don’t want to do what is necessary to cover nearly as many people as Obamacare does.

It’s still very possible that repeal will happen, no replacement will materialize, and many millions will lose coverage. But if Dems can manage this skillfully, they might have some leverage to try to bring about a less catastrophic outcome than we might have expected.


* GOP REPLACE PLAN WOULDN’T GUARANTEE COVERAGE: The New York Times accurately reports that at his confirmation hearing as HHS secretary, Tom Price repeatedly refused to say that the GOP replace plan would strive for the same coverage guarantee that the ACA does:

He said the administration could put in place “a different construct” that “would allow for every single person to gain access to the coverage that they want and have nobody fall through the cracks.” He did not say how the Trump team would guarantee such protection.

That’s the essence of the matter. Trump keeps saying that “everybody” will be covered, but the GOP replacement will likely be premised on the spin that “access” to coverage is the same as guaranteeing it.

* POLLS SHOW SUPPORT FOR REPEAL ALONE IS VERY LOW: A new CNN poll finds that only 21 percent of Americans support repealing the ACA regardless of whether a replacement is ready. By contrast, 55 percent support repeal only with replacement parts passing at the same time, and 22 percent want the ACA left alone — a total of 77 percent.

Meanwhile, a new CBS News poll finds that only 22 percent want repeal alone — while 66 percent say the law has done some good things but needs changes. All this once again suggests that the politics of repeal may be shifting against Republicans.


Only about one-third (36 percent) say they think it does enough to eliminate conflicts of interest, 62 percent think it doesn’t go far enough. Two-thirds think he hasn’t disclosed enough information about his financial situation and business connections, and more, 74 percent, say Trump should release his tax returns, including 96 percent of Democrats, 71 percent of independents and 51 percent of Republicans.

This could translate into actual pressure on congressional Republicans to exercise meaningful oversight, if the press uncovers conflicts or corruption while Trump is in office.

* HOW TO HOLD TRUMP ACCOUNTABLE FOR CONFLICTS: In an interview with Politico, Rep. Ruben Gallego of Arizona suggests Dems should use measures like Trump’s infrastructure measure to try to force transparency about his conflicts. If Trump needs Dem support, Politico notes, Dems could try to use this leverage to “make Trump release his taxes to show that he won’t personally benefit from any provision in the bill.”

As I reported yesterday, this is the sort of guerrilla tactic that Members of Congress who want to force transparency are going to have to try, even if the chances of success are not high.

* AMERICANS THINK TRUMP WILL BENEFIT RICH, CORPORATIONS: A new CBS News poll finds that 65 percent of Americans think Trump’s policies will mostly benefit the rich, and 72 percent think they will benefit large corporations.

However, 61 percent also think Trump will keep a significant number of jobs from going overseas. Whether that happens or not, you can easily see Trump using high profile announcements of “saved” jobs here and there as cover to move a pro-rich, pro-corporate agenda.


We still do not know exactly what ties Trump and his enterprises have to various Russian interests because he won’t disclose basic financial information, including his tax returns….Trump’s refusal to truly separate himself from his businesses means that ethical conflicts could well start on Day One of his presidency. It is not paranoid to wonder whether foreign leaders will have ways of influencing Trump that we will know nothing about.

Yes. The problem is not merely Trump’s refusal to divest, but also that, because of the opacity of his holdings, we cannot know whether conflicts or corruption are taking place in a given situation.

* AND LATINOS ARE STRESSED ABOUT TRUMP PRESIDENCY: A new Post poll finds that 54 percent of Latinos say that Trump’s election as president has increased their usual amount of stress. Gosh, what could possibly explain that?