AGAINST THE GRAIN

For Democrats, the Politics of Obamacare Are Still Dismal

President Obama cheered the Supreme Court’s ruling, but the biggest test for his health care law’s sustainability is next year’s presidential election.

Josh Kraushaar
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Josh Kraushaar
July 7, 2015, 4 p.m.

Un­der­stand­ing the polit­ics of the pres­id­ent’s health care law has nev­er been com­plic­ated. It was barely passed through Con­gress des­pite huge Demo­crat­ic ma­jor­it­ies in 2009, be­came the driv­ing force be­hind the GOP’s takeover of the House in 2010, and again was the lead­ing is­sue Re­pub­lic­ans cam­paigned on to re­take the Sen­ate in 2014. Nearly 15,000 ad­vert­ise­ments aired about Obama­care in the last week of last year’s midterms, and 94 per­cent of the mes­saging was neg­at­ive. One week later, Re­pub­lic­ans won nine Sen­ate seats and net­ted their largest House ma­jor­ity since the 1920s. For Re­pub­lic­ans, it has been the polit­ic­al gift that keeps on giv­ing.

Yet even though pub­lic opin­ion re­mains un­fa­vor­able to­wards the law, Demo­crats re­main in deni­al about its polit­ic­al stand­ing. Its sup­port­ers rushed to de­clare the is­sue closed for de­bate after the Su­preme Court’s rul­ing last month that fed­er­al sub­sidies re­mained con­sti­tu­tion­al. “After more than 50 votes in Con­gress to re­peal or weak­en this law, after a pres­id­en­tial elec­tion based in part on pre­serving or re­peal­ing this law; after mul­tiple chal­lenges to this law be­fore the Su­preme Court—the Af­ford­able Care Act is here to stay,” Pres­id­ent Obama pro­claimed after the rul­ing.

In real­ity, the law will likely re­main a pivotal ele­ment of the GOP’s ar­gu­ment against Hil­lary Clin­ton in 2016—and for Re­pub­lic­ans in the battle­ground con­gres­sion­al con­tests. Adding to the polit­ic­al mo­mentum for op­pon­ents of the law are un­pop­u­lar man­dates and pro­vi­sions that were delayed after the midterms but will be tak­ing ef­fect as the pres­id­en­tial elec­tion draws closer. Most sig­ni­fic­antly, lead­ing health in­sur­ance com­pan­ies are seek­ing sig­ni­fic­ant in­creases for premi­ums, as they’re find­ing their cus­tom­ers are sick­er than ex­pec­ted. At the same time, fed­er­al “risk cor­ridors” es­tab­lished to help cov­er their rising costs are ex­pir­ing and not likely to be re­newed by a cost-con­scious Con­gress.

(RE­LATED: Re­pub­lic­ans to Test White House’s Obama­care Swag­ger)

Even the Obama ad­min­is­tra­tion, by its own ac­tions, has demon­strated the un­pop­ular­ity of its sig­na­ture law. In re­spond­ing to polit­ic­al res­ist­ance to Obama­care, the White House pur­posely delayed crit­ic­al ele­ments of the law un­til after the 2014 midterm elec­tions—when Obama would be head­ing out of of­fice. Me­di­um-sized busi­nesses won’t be re­quired to provide health in­sur­ance to their em­ploy­ees un­til next year—a man­date that op­pon­ents of the law ar­gued would be overly bur­den­some and drag the eco­nomy down. Con­sumers who re­ceived ex­ten­sions for their old health care plans won’t be able to keep them past 2017, re­new­ing the pro­spect of an­oth­er flood of polit­ic­ally-dam­aging can­cel­la­tion no­tices. The fund­ing streams to the in­sur­ance com­pan­ies—or bail­out, in the GOP par­lance—that would help re­duce con­sumer costs are un­likely to be main­tained, giv­en how ex­pens­ive it would be. The the­ory was that if they kept buy­ing time, pub­lic opin­ion would slowly get with the pro­gram re­gard­less of its fisc­al sus­tain­ab­il­ity.

Polling sug­gests that the White House was a bit too clev­er for its own good. Sup­port for the law has barely trickled up­wards in re­cent months. That’s not an en­cour­aging sign, giv­en the many polit­ic­al land mines that are around the corner. Last month’s NBC News/Wall Street Journ­al poll found an out­right 50 per­cent ma­jor­ity of Amer­ic­ans sup­port­ing either full re­peal or “a ma­jor over­haul.” Forty-sev­en per­cent sup­por­ted smal­ler changes, with only 8 per­cent want­ing to main­tain the status quo. The num­bers were stable from the pre­vi­ous year. A Kais­er Fam­ily Found­a­tion track­ing sur­vey found sup­port for the law re­ceiv­ing a small bounce im­me­di­ately after the Su­preme Court’s rul­ing, with 43 per­cent view­ing it fa­vor­ably and 40 per­cent un­fa­vor­ably. But the same sur­vey found more re­spond­ents say­ing it “dir­ectly hurt” their fam­ily (24 per­cent) than say­ing it helped (19 per­cent).

(RE­LATED: Did the Su­preme Court Just Bol­ster Boehner’s Obama­care Law­suit?)

There’s been an as­sump­tion that just be­cause Demo­crats con­tin­ue to suf­fer at the polls be­cause of the law’s un­pop­ular­ity, Re­pub­lic­ans will even­tu­ally be able to roll it back. Op­pos­i­tion to the law is still wide and fairly deep, and most GOP cam­paigns plan on us­ing it against their Demo­crat­ic rivals. (By re­cruit­ing sev­er­al former of­fice­hold­ers in key Sen­ate races, Demo­crats have lead­ing Sen­ate can­did­ates on re­cord in fa­vor of the law.) But in or­der to trans­late that op­pos­i­tion in­to ac­tion, Re­pub­lic­ans would need to win the pres­id­ency and then spend valu­able polit­ic­al cap­it­al on mak­ing changes. The Su­preme Court’s rul­ing on the leg­al­ity of the Obama­care sub­sidies en­sured that any changes made to the law will be tak­ing place in the polit­ic­al realm, where pub­lic of­fi­cials will be held ac­count­able for their ac­tions.

Among Re­pub­lic­ans, there’s a heated de­bate un­der way about the Obama­care strategy in a best-case scen­ario in which they win the pres­id­ency and hold the Sen­ate in 2016. Sen. Ben Sas­se of Neb­raska out­lined three du­el­ing GOP camps in a re­cent Na­tion­al Re­view column. One fac­tion would prefer to keep it alive as a polit­ic­al is­sue in per­petu­ity, talk­ing about re­peal­ing the law but oth­er­wise keep­ing the core of it in place. A second would un­der­take a scorched-earth le­gis­lat­ive strategy to fully re­peal the law—even killing the fili­buster to lower the ne­ces­sary votes to pass le­gis­la­tion—dis­reg­ard­ing any of the polit­ic­al con­sequences. The third group, which Sas­se la­bels the “Re­place­ment Caucus,” would make sig­ni­fic­ant changes to the law after cam­paign­ing on a re­form-ori­ented health care agenda in the pres­id­en­tial elec­tion. That’s the most ten­able ap­proach—and the fact that Sas­se, a hard-line Sen­ate con­ser­vat­ive, is call­ing for something oth­er than out­right re­peal is telling. (Sas­se still sup­ports re­peal­ing the law but only with a re­place­ment plan in hand.)

If Re­pub­lic­ans win the pres­id­ency, the polit­ic­al mo­mentum—and votes for rolling back core ele­ments of Obama­care—would be in place. In that scen­ario, Re­pub­lic­ans would have won three out of four elec­tions, and a de­pleted Demo­crat­ic Party would be in dis­ar­ray. Re­pub­lic­ans could cred­ibly claim a health care man­date, giv­en how prom­in­ently the is­sue played in re­cent elec­tions. And Demo­crats would prob­ably want some kind of Re­pub­lic­an buy-in on health care, short of the polit­ic­ally un­ten­able calls for re­peal. Pres­id­ent Obama would be re­tired, lack­ing the clout to pres­sure Demo­crats to de­fend everything in the le­gis­la­tion so closely tied to his pres­id­ency.

(RE­LATED: The Su­preme Court Obama­care Case, Ex­plained)

Look at the 2018 Sen­ate map, and the pro­spect of a cen­ter-right health care re­form con­stitu­ency isn’t so out­land­ish. Re­pub­lic­ans cur­rently hold 54 Sen­ate seats and, if they win the pres­id­ency, are un­likely to lose their ma­jor­ity. Mean­while, there are five red-state Demo­crats up for reelec­tion that year—Sens. Joe Manchin of West Vir­gin­ia, Heidi Heitkamp of North Dakota, Claire Mc­Caskill of Mis­souri, Joe Don­nelly of In­di­ana, and Jon Test­er of Montana—and sev­er­al more battle­ground-state Demo­crats ex­pect­ing com­pet­it­ive reelec­tions. Polit­ics, not prin­ciple, will be their man­tra.

To be sure, such a scen­ario isn’t the like­li­est, giv­en that it re­quires a GOP pres­id­en­tial vic­tory and the pro­spect of Re­pub­lic­an unity—two things that have been in short sup­ply in re­cent years. But it isn’t far-fetched either, es­pe­cially giv­en that win­ning elec­tions of­ten leads to le­gis­lat­ive mo­mentum. Obama was able to re­vamp the na­tion’s en­tire health care sys­tem, even with wide­spread pub­lic op­pos­i­tion to his plan. Ima­gine what Re­pub­lic­ans could do if they take con­trol, with a ma­jor­ity of the pub­lic sup­port­ing change to Obama­care.

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