Republican attacks on the Affordable Care Act are like the playlist on an oldies radio station: the same songs replayed with mind-numbing regularity, even as they appeal to a decreasing number of people each year. In a federal courtroom in Texas Wednesday, a case brought by 20 Republican state attorneys general and governors got underway that could, if successful, overturn the Affordable Care Act and, in a true doomsday scenario, result in a preliminary injunction that would stop the ACA in its tracks — just as millions of Americans need to begin thinking about their insurance coverage for 2019. Even if Republicans win, they lose.
A quick review: Last year, as part of the tax-reform package, Republicans repealed the tax penalty for people who do not have health insurance. That penalty was the basis of the Supreme Court ruling that upheld the Affordable Care Act in 2012. That, in turn, led Republican officials to turn to the courts, making the argument that with the tax penalty gone, the ACA is now unconstitutional.
The case is being defended by a coalition of Democratic state attorneys general because the Trump administration is refusing to do so. Instead, the Trump Justice Department filed a brief taking a negative position on several of the ACA’s provisions, most notably the law’s ban on allowing people to be denied coverage or charged higher rates if they have preexisting conditions to be overturned. The administration also asked the judge not to issue an injunction putting an immediate stop to the ACA until after issuing a ruling on the case. That request, if granted, would effectively push any action on that matter till after the open enrollment period for 2019 — and the November elections.
But whatever the judge in Texas decides, Republicans pursuing this case will have succeeded in reminding voters — just as the midterms loom — that they support the destruction of the now popular ACA, increasing the odds of a blue wave. This is the definition of a political suicide mission.
Nearly a decade on from the ACA’s passage, continued attacks on the law play poorly with the public. A Monmouth University poll last month found a plurality of voters said that when it came to voting on issues, health-care policy was the one most likely to determine which candidates received their support in November. And though Republicans may think attacking health care plays to their base, it was almost 4 out of 10 Democrats who identified health care as the leading issue they were basing their vote on. GOP voters were more likely to go with immigration and the economy.
Republican thinking remains mired in the past. The ACA remained unloved by many through 2016 – in September of that year, Gallup found a majority of Americans disapproved of the laws, with negative feelings especially strong among Republicans. Exit polling conducted on the day of the presidential election showed that of the 45 percent of voters who said the ACA went too far, 4 out of 5 would vote for Donald Trump. But Trump’s election had the unexpected impact of making arguments about the repeal of the ACA no longer theoretical but real to Americans. That resulted in mobbed town halls, where voters confronted members of Congress about their intent to repeal the ACA, and by April 2017, a majority of voters said they supported the ACA.
Moreover, even at the height of the ACA’s unpopularity, the ban on allowing health insurers to refuse to cover people with preexisting conditions was always popular. And now? A poll released earlier this week by the Kaiser Family Foundation found that 3 out of 4 Americans say it’s “very important” the ACA continue to ensure that people with preexisting conditions can receive coverage, with a slightly smaller share (72 percent) saying people should not be charged more as a result of their health. It’s no mystery why: The same poll found that 6 in 10 people said either they or someone in their immediate household suffered from a condition that could be termed a preexisting condition.
At the same time, support for broader health-insurance reform is surging. Medicare-for-all, you might recall, was viewed as a radical position as recently as two years ago. Now polls show a majority of Americans now back Medicare-for-all, with a KFF survey from earlier this year finding a majority of Republicans support opening up Medicare to all comers as long as they could choose to keep their employer insurance instead.
It seems obvious that the Republican pols bringing this lawsuit believe a golden oldie from days past will rile up their most devoted voters. But when it comes to health care and health insurance, that base is shrinking. The once-popular hit from earlier this decade will, instead, simply serve to remind Americans how out of tune with the present Republicans really are.