Nancy Pelosi famously said in 2010 about the Affordable Care Act that “We have to pass the bill so that you can find out what is in it, away from the fog of the controversy.” Republicans chopped off the last clause, took the quote out of context and claimed that Pelosi was hiding something, when in fact the bill had been available for some time for anyone to read, and Pelosi only meant that once it became law and the “fog of the controversy” — the negative ads, the insane GOP lies about “death panels” and the like — faded away, Americans would come to understand the benefits it actually provided.

She was wrong, in that the controversy never faded away. Yet many people at the time, myself included, thought that once it was implemented, the bill’s popularity would quickly increase. We were wrong about that, too, mostly because Republicans never stopped attacking it for a moment, ensuring that opinions about the law would always fall along partisan lines.

But a full eight years after it became law, and almost two years after Barack Obama left office, Obamacare is finally winning.

The most common theme in campaign ads isn't Trump. It's pre-existing conditions, according to Opinions writer Paul Waldman. (Kate Woodsome, Paul Waldman, Danielle Kunitz/The Washington Post)

Because the law is so complex, judging its substantive success is complex, too. It brought coverage to tens of millions of Americans, for instance, though large gaps remain. But as a political matter, what for so long was a problem for Democrats has become a problem for Republicans.

It’s happening on multiple fronts. First, polls over the past year or so have shown the law to be consistently popular — more so than, for instance, the tax cut Republicans thought would be the key to a midterm election victory. When even Fox News polls show the law getting more support than ever, the world is obviously not as Republicans would like it to be.

Second, instead of demanding that the ACA be torn from its foundations and set ablaze, the public seems more inclined to entrench its protections and expand its coverage. As the Associated Press reports, in the four conservative states where voters got initiatives on the ballot to accept the ACA’s expansion of Medicaid and insure thousands more people, the conservative lawmakers who refused to do so for years have been shocked by the popularity of the measures, with polls showing them with a good likelihood of winning:

Nebraska isn’t the only conservative state where residents are bypassing a legislature that has refused to expand Medicaid.
Voters in two other Republican-dominated states, Idaho and Utah, also will decide in November whether to expand the health insurance program to more lower-income Americans. Another ballot initiative, in Montana, seeks to raise a tobacco tax to keep funding a Medicaid expansion that is set to expire.
It also has become a focal point in numerous governor’s races.
The election-year push in conservative-leaning states for one of the main aspects of Obama’s health care law has surprised many Republican lawmakers after they spent years attacking it.

Perhaps it shouldn’t have been so surprising after the backlash they experienced when they tried to repeal the ACA last year and it became apparent how popular Medicaid is. In the latest Kaiser Family Foundation tracking poll, by a margin of 56 percent to 37 percent, voters in states that did not accept the expansion of Medicaid — conservative states all — now say they support expansion.

Then, of course, there’s the fact that the ACA’s guarantee of coverage for people with preexisting conditions has suddenly become the hottest issue in the midterm elections, so much so that one Republican candidate after another is airing ads proclaiming his fervent commitment to maintaining those protections — the very protections Republicans have been trying to destroy with repeal efforts and lawsuits aimed at getting the law struck down. You can find few better signs of the political success of a law than when the people who fought against it and are still trying to destroy it rush to assure voters that in fact they dearly love what it does.

And every time another Republican airs an ad claiming that he wants to mandate protections for preexisting conditions, he only reinforces one of the ideas that drove the creation of the ACA in the first place: that it’s the responsibility of government to ensure that every American has secure health coverage.

Just to be clear, none of this means that the ACA is safe. Senate Majority Leader Mitch McConnell (R-Ky.) has said that if Republicans have the votes next year, they will try again to repeal the law. The Trump administration is encouraging states to add work requirements to Medicaid, the purpose of which is simply to force recipients to navigate a bureaucratic maze so that the state can find a justification to kick them off their health coverage. To be in charge of the Medicaid program, Trump just appointed Mary Mayhew, a former aide to America’s worst governor, Paul LePage of Maine, who refused to accept the expansion even after his state’s voters passed an initiative requiring him to do so; her mission seems to be to destroy Medicaid from the inside.

But with the possibility of four more holdout states expanding Medicaid and Republicans now enacting a ridiculous charade of pretending to support the ACA’s most popular provision, it’s becoming clear that in a fundamental way, Obamacare has won. Pelosi’s prediction is coming true, even though it took eight years — and, importantly, the departure of the president who brought Republicans to such fits of rage.

Once people started seeing the benefits of the ACA, it did indeed become more popular. It still has problems and leaves gaps, and Democrats are becoming united around the idea of moving past it to go all the way to universal coverage. But it’s looking increasingly unlikely that we will revert to the unspeakably cruel health insurance system we had before the ACA took effect. Even if that’s what Republicans would still prefer.


Post Opinions writer Paul Waldman dissects the current climate in political ads. (Kate Woodsome, Danielle Kunitz, Paul Waldman/The Washington Post)