Another year, another HealthCare.gov enrollment period and another series of Republican efforts to repeal, defund or otherwise dismantle the Affordable Care Act.
So when will the GOP learn to stop worrying and love Obamacare?
The question is not quite as crazy as it sounds when you consider Americans’ attitudes toward Obamacare’s actual provisions.
Despite the bad publicity surrounding the health-care overhaul, most Americans who have received coverage through the government’s exchanges report being happy with it. More than seven in 10 newly insured Americans rate both the quality of their health care and their coverage “excellent” or “good,” according to a new Gallup poll. That’s about in line with the ratings that insured Americans overall give their health insurance. When it comes to the costs of their coverage, people newly insured through Obamacare are actually more satisfied than the general population of insured people.
Other polling has found similarly positive views from exchange participants, as well as broad support for many of the law’s other major provisions (such as allowing young people to stay on their parents’ insurance until age 26, guaranteeing coverage to those with preexisting conditions, eliminating lifetime caps on how much insurance companies must pay for a person’s health care and requiring coverage of birth control). The only big provision Americans dislike — and not terribly strongly, at that — is the individual mandate, which is necessary for some of those other popular provisions to work, and which people may eventually accept just as they do auto insurance mandates.
All of this makes me wonder if Obamacare will eventually follow the same political arc as Medicare: fiercely opposed by conservatives until they realize people really like it, leading both parties to become champions of its expansion.
For decades, Medicare was roundly opposed by Republicans (as well as some key Democrats). Ronald Reagan, at the start of his political career, predicted that Medicare would usher in Soviet-style socialism. Should Medicare pass, he warned, “you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”
Over subsequent decades, of course, Republican attitudes toward Medicare evolved, partly because of industry lobbying and partly because of pressures from a very active voting demographic (the elderly) that benefited from the entitlement. By the mid-2000s, President George W. Bush and a Republican-led Congress had delivered a huge, expensive, deficit-financed expansion of the program to cover prescription drugs. Today, both parties are loath to even hint at paring back Medicare. Paul Ryan’s proposal to overhaul the Medicare system in the name of fiscal conservatism appears to be more of a political liability than a base-mobilizer.
We may already be seeing a similar evolution in Republican politicians’ attitudes toward Obamacare’s provisions. Ahead of the recent midterms, Senate Republican leader Mitch McConnell found himself threading a very fine needle in which he advocated repealing Obamacare without causing his Kentucky constituents who’d gained insurance under the law to lose their coverage.
Of course, there are two key differences between the long-term political dynamics of Medicare and those of Obamacare: who benefits most from the laws, and whether those happy beneficiaries credit the law in question for their good fortune.
The primary beneficiaries of Medicare are the elderly, who, as I mentioned, have high voter turnout rates. Those of the Affordable Care Act, on the other hand, are disproportionately low-income people who (a) don’t vote in high numbers and, (b) when they do vote, usually cast ballots for Democrats. If the GOP has written off Obamacare beneficiaries as lost to the Democrats forever, then maybe support for the law will never become as bipartisan as it is for Medicare.
The other issue is that while Americans broadly applaud most of the law’s provisions, they still hate the law itself. Gallup recently found, for example, that the share of Americans who approve of the Affordable Care Act is at a record low of 37 percent. Such paradoxical poll results suggest that either Americans don’t understand what Obamacare does or their feelings about the law’s (nick)namesake have overshadowed their assessment of the law itself.
Which is why what we may ultimately end up with, when all the political peacocking has petered out, is not so much an outright repeal but a rebranding. The arc of the political universe is long, but — for better or for worse — it bends toward keeping popular subsidies and entitlements in place.