The Patient Protection and Affordable Care Act -- better known as "Obamacare" -- is winning.
From March 23, 2010, the day it was signed into law, to November 6, 2012, the day President Obama won reelection, the law's survival was continuously in doubt. House Republicans voted to repeal it more than 30 times. Conservative judges voted to invalidate it. Every Republican presidential candidate promised to get rid of it. But the law endured. It now seems certain to be fully implemented in 2014, as planned. And Republicans are making their peace with it.
On Wednesday, Florida's Rick Scott became the seventh Republican governor to accept Obamacare's Medicaid expansion. His reversal was particularly important because Scott, a tea party-backed former hospital executive who won election in 2010 in large part due to his opposition to Obamacare, had sworn to reject the Medicaid dollars. In conducting a complete about-face, he created a template for other Republican governors who excitedly said no to the money before the election to reevaluate in light of Obama's win.
"It doesn’t matter what I believe," Scott told reporters. "The Supreme Court made its decision. We had an election in the fall, and the public made their decision. Now the president’s health-care law is the law.”
After a long fight, that last sentence -- "the president’s health-care law is the law" -- is becoming increasingly accepted on the right. Shortly after the election, House Speaker John A. Boehner (R-Ohio) called Obamacare "the law of the land." And in a Reuters story, Avik Roy and Doug Holtz-Eakin, two of the right's more influential and enthusiastic advocates of repeal, are counseling Republicans to accept that Obamacare has "become politically impossible to repeal," and to instead focus their efforts on using it as a platform for "a comprehensive, market-oriented health-care agenda."
That's Scott's new theory, too. In return for accepting the Medicaid expansion, Scott got approval for a Medicaid experiment in his state that would privatize some of the program in the hopes of cutting costs.
This is the conversation the Obama administration has long wanted to have. As Matt Yglesias notes, in 2009, the White House was desperate for "a bipartisan bill that a dozen or more Senate Republicans would vote for." That would have meant making deals with Republicans that would have moved the bill to the right. But it also would've meant getting Republican sign-off for, and help on, the law itself.
They didn't get that in 2009, but Republicans are beginning to come around in 2013. The health-care law goes into effect next year, and implementation is sure to be rocky -- all the more so because so many states have left the bulk of the work up to the federal government. But so long as Obamacare is accepted as the law of the land, and repeal is dismissed by most Republicans as little more than a pleasant fantasy, then a constructive process can begin in which Republicans seize on problems with the law as an opportunity to reform the reforms -- and through that process, begin to buy into the new system. That's how the fight over Obamacare ends, and the work of health-care reform continues.