There are dilemmas and then there are real dilemmas. On health care, Republicans are in a real dilemma.
Congressional Republicans promised their base a million times that they would repeal and replace the much-despised (by the GOP base) Affordable Care Act. No ambiguity whatsoever. In the House, they voted over 60 times to repeal the ACA, though the replace part was a little vague. Now that Republicans occupy the White House and hold majorities in the House and Senate, the Republican base would be rewarded with repeal of Obamacare, right?
But here comes the dilemma. While Americans are not exactly deliriously happy with Democrats’ health blueprint, they like it a lot better than the Republican House-passed American Health Care Act. It’s unlikely that Senate Republicans will come up with something anytime soon that will be much more popular than the version passed by their House colleagues.
So, do Hill Republicans betray all of those promises to their base to repeal and replace Obamacare, or do they pass something that people will hate even more? That’s what you call a dilemma.
Obamcare has had a rocky ride. You can have a spirited argument over just how hard Democrats tried in 2009 and 2010 to get Republican support for the controversial bill, but basically Democrats took advantage of very large majorities in the House and Senate to jam the ACA through Congress in early 2010—and paid the price for it by losing 63 seats and their House majority, along with six Senate seats, in that November’s general election. The aftershocks continued four years later, as Democrats lost nine Senate seats and their Senate majority (along with 13 more House seats) in 2014. The ACA was a Pyrrhic victory for Democrats, at least electorally.
When it was first enacted, the ACA appeared to get a positive response; the nonpartisan Kaiser Family Foundation monthly health care polls showed 50 percent of Americans in July 2010 had a favorable opinion of the ACA, and 35 percent saw it unfavorably. But soon Obamacare’s poll numbers turned south, with unfavorable numbers exceeding favorable for much of the next six years—favorables generally running in the mid-30s and 40s, unfavorable in the 40s and low 50s. But that was among all Americans; the ACA was seen very favorably by Democrats and somewhat unfavorably by independents. Republicans, meanwhile, detested the law.
But starting soon after last November’s election, the prospect of the ACA actually being repealed began to sink in, and its popularity increased. In the June 14-19 Kaiser poll of 1,208 adults nationwide, 51 percent had a favorable view, 41 percent unfavorable; 29 percent had a very favorable view, and 27 percent a very unfavorable opinion. Contrast that with the July 2014 Kaiser poll that showed 37 percent favorable, 53 percent unfavorable, with just 15 percent seeing it very favorably, 35 percent very unfavorably.
In contrast with Obamacare’s gradual descent, public opinion on the Republican House-passed AHCA sunk like a lead balloon. The new Kaiser poll showed just 30 percent had a favorable view, 55 percent unfavorable. The Kaiser numbers are backed up by plenty of other data. The June 17-20 NBC News/Wall Street Journal poll by GOP pollster Bill McInturff of Public Opinion Strategies and Democratic pollster Fred Yang, two of the best in the business, had 41 percent saying Obamcare was a good idea, 38 percent that it was a bad idea.
That’s hardly anything for Democrats to write home about. But for the AHCA, just 16 percent said it was good idea, 48 percent a bad one. Within those numbers, 34 percent of Republicans thought it a good idea, 17 percent bad idea, and 47 percent had no opinion. Among independents, it was 16 percent good idea, 48 percent bad idea, 36 percent no opinion, while among Democrats it was 4 percent good idea, 73 percent bad idea, 22 percent no opinion.
Polling this month by McInturff and POS for the American Medical Association in six states shows the ACA had net good-idea numbers of 11 percent in Colorado and Ohio, 8 percent in Nevada, 1 percent in Alaska, minus-6 percent in Arkansas, and minus-12 percent in Tennessee. For the GOP House-passed legislation, it was minus-14 in Arkansas, minus-20 in Tennessee, minus-33 percent in Alaska, minus-34 in Nevada, minus-40 percent in Ohio and minus-41 in Colorado.
Simply put, on health care, congressional Republicans are damned if they do and damned if they don’t. The fact that the initial plan from Senate Majority Leader Mitch McConnell’s (a pretty smart guy) had at least four Republicans (Ted Cruz, Mike Lee, Rand Paul, and Ron Johnson) who thought it didn’t go far enough in eliminating Obamacare, and at least five (Susan Collins, Lisa Murkowski, Shelley Moore Capito, Dean Heller, and Rob Portman) that worried it went too far showed that this was a matter of splitting the baby.
If I were a Senate Republican, I would support the bill, knowing that it would probably fail anyway, then tell my base that ‘I tried,’ then move quickly on to other issues. People take health care very personally; passing something this hated by voters would be even worse than breaking their repeal promise. As Sen. Joe Manchin said of West Virginians and health insurance last month, “They’ve got something they never had before. They don’t know how they got it, they don’t know who gave it to them. … They’re going to know who took it away from them.”
This is legislation that would be better handled next year, in a back room, with pragmatic House and Senate members from both parties trying to figure out what is working, what isn’t working, and how to make it work better.
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