Everything About Obamacare Politics Is About to Change

As data on the health law replaces speculation about its effects, Republicans’ national Obamacare attack strategy threatens to come apart at its seams.

JERSEY CITY, NJ - OCTOBER 03: A pamphlet for the Affordable Care Act, better known as ObamaCare, sits on a table at a branch of the Metopolitan Family Health network, on October 3, 2013 in Jersey City, New Jersey. The online marketplaces where people can sign up for Obamacare opened on Monday, though the website has been plagued with issues, including high volumes of traffic, making it difficult for people to access the site. The Jersey City Metropolitan Family Health branch chose to advertise the new health insurance option and are offering to help people sign up - while the website is down, they are taking names and phone numbers to make appointments for next week. 
National Journal
Scott Bland and Alex Roarty
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Scott Bland and Alex Roarty
Oct. 7, 2013, 5:45 p.m.

The polit­ic­al de­bate over the Af­ford­able Care Act was the same every­where. House can­did­ates in Cali­for­nia were dis­cuss­ing the in­di­vidu­al man­date and cov­er­age for preex­ist­ing con­di­tions just like Sen­ate can­did­ates in Ken­tucky were. Voters viewed the law through a na­tion­al lens.

Un­til now.

Next year all Obama­care polit­ics will be loc­al. The law’s im­ple­ment­a­tion has already been dra­mat­ic­ally dif­fer­ent from state to state — read­ing loc­al cov­er­age, it’s some­times hard to be­lieve the same law is tak­ing ef­fect every­where. That means its polit­ics will also be dif­fer­ent from Sen­ate race to Sen­ate race, House race to House race.

The shift will cut both ways: In some in­stances it will help Demo­crats; in oth­ers, Re­pub­lic­ans. But it presents a chal­lenge most press­ing for Re­pub­lic­ans, who have touted the law as cent­ral to re­tak­ing the Sen­ate and ex­pand­ing their already deep ma­jor­ity in the House. If the law’s polit­ics are dif­fer­ent in every cam­paign, can the GOP en­sure it’s a win­ning is­sue every­where?

Nowhere is the emer­gence of loc­al Obama­care polit­ics more ap­par­ent than in an Ari­zona con­gres­sion­al race. Demo­crat­ic Rep. Ann Kirk­patrick, who rep­res­ents a sprawl­ing, con­ser­vat­ive-lean­ing dis­trict, had heard plenty about the health care law. Nearly every TV ad Re­pub­lic­ans ran against her in 2012 fea­tured Obama­care. Already, the Na­tion­al Re­pub­lic­an Con­gres­sion­al Com­mit­tee is run­ning ra­dio ads ty­ing Kirk­patrick — again — to the law.

But this time around, Kirk­patrick has a new re­but­tal. Earli­er this year, the Ari­zona GOP rup­tured in civil war as one group, led by Re­pub­lic­an Gov. Jan Brew­er, teamed with Demo­crat­ic le­gis­lat­ors to ex­pand the state’s Medi­caid pro­gram us­ing fed­er­al funds from Obama­care. Both state le­gis­lat­ors run­ning against Kirk­patrick voted and lob­bied against the Medi­caid ex­pan­sion in the Ari­zona House.

That’s giv­en Kirk­patrick an open­ing. Her dis­trict is rur­al, poorer than av­er­age, and has a large Nat­ive Amer­ic­an pop­u­la­tion — all ele­ments that Kirk­patrick says will make Obama­care es­pe­cially pos­it­ive in her re­gion.

“Any­one who cam­paigns on re­peal­ing the law or op­pos­ing Medi­caid ex­pan­sion is really out of step with this dis­trict,” Kirk­patrick said in June after the state Le­gis­lature agreed to ex­pand the state’s Medi­caid pro­gram. “They just don’t know the dis­trict.”

Ari­zona state Rep. Adam Kwas­man, one of the Re­pub­lic­ans who voted against ex­pand­ing Medi­caid and is con­sid­er­ing a cam­paign against Kirk­patrick, isn’t shy­ing away from a fight. “If she wants to de­fend a pro­gram like that, who­ever she runs against: Bring it on,” he said.

In some states, even Re­pub­lic­an-run gov­ern­ments are ex­press­ing some level of buy-in on Obama­care that com­plic­ates GOP ef­forts to brand the law a fail­ure and waste of funds. Take Iowa, for in­stance, which fea­tures a com­pet­it­ive, open-seat Sen­ate race next year. Des­pite Re­pub­lic­an con­trol of the gov­ernor­ship, the state has com­prom­ised with the fed­er­al gov­ern­ment to help set up its own state-based ex­change. “While we have vary­ing opin­ions re­gard­ing the Af­ford­able Care Act, we have not let our dif­fer­ences pre­vent us from meet­ing our re­spons­ib­il­it­ies and mov­ing Iowa for­ward,” Re­pub­lic­an Gov. Terry Bran­stad wrote in a let­ter to Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us.

The friend­li­ness of some GOP of­fi­cials to­ward Obama­care fur­ther weak­ens the GOP’s rhet­or­ic. Rep. Dav­id Joyce, R-Ohio, is a top tar­get of Demo­crats, and an avowed op­pon­ent of Obama­care. But his home-state gov­ernor, Re­pub­lic­an John Kasich, en­dorsed ex­pand­ing Medi­caid there. And be­cause Kasich is also seek­ing reelec­tion in 2014, he’ll likely tout his own de­cision to co­oper­ate with the fed­er­al health care pro­gram even as Joyce takes aim at it.

“Will his cri­ti­cism put him in the cross-hairs of Kasich, who will be also on the bal­lot?” said Brock Mc­Cle­ary, a Re­pub­lic­an poll­ster. “That’s a fas­cin­at­ing dy­nam­ic.”

Re­pub­lic­ans are con­vinced Obama­care will ul­ti­mately be a net pos­it­ive for them in every race, even as they ac­know­ledge its polit­ics will vary from one to an­oth­er.

Take New York, for ex­ample, where the icon­ic gro­cery chain Weg­mans is an up­state staple. The com­pany an­nounced earli­er this year it was cut­ting be­ne­fits for part-time work­ers. The news, sim­il­ar ex­amples of which can be found in most areas, is the per­fect op­por­tun­ity to show voters how the law is hurt­ing their com­munity, ac­cord­ing to An­drea Bozek, spokes­wo­man for the Na­tion­al Re­pub­lic­an Con­gres­sion­al Com­mit­tee. “Any­time you can take a na­tion­al is­sue that is in­creas­ingly un­pop­u­lar and loc­al­ize it for folks and show voters how it can dir­ectly im­pact about the pock­et­book and health care, two things they care pas­sion­ately about, it’s a very ef­fect­ive tool to have,” she said.

That em­phas­is on loc­al stor­ies is doubly im­port­ant be­cause of the ef­fect it has on loc­al news. In most Sen­ate and House races, voters’ at­ti­tudes will be shaped by loc­al TV sta­tions and news­pa­pers more than their na­tion­al coun­ter­parts.

Of late, loc­al cov­er­age has been de­term­ined by re­lease of the av­er­age premi­um rates for the state-based health care ex­changes. And just as with loc­al of­fi­cial re­ac­tion and Medi­ciad ex­pan­sion, states will of­fer sig­ni­fic­antly dif­fer­ent premi­um rates on their health care ex­changes (those rates also vary from city to city with­in a state).

In Utah, a fam­ily of four that doesn’t qual­i­fy for gov­ern­ment sub­sidies would pay $656 for the av­er­age in­sur­ance plan, ac­cord­ing to data re­leased by the Obama ad­min­is­tra­tion; in Alaska, the same fam­ily would pay nearly double that, at $1,131. Utah fea­tures one of the race’s most com­pet­it­ive House races, where Rep. Jim Math­eson is poised for a re­match against the wo­man he nar­rowly de­feated last year, Re­pub­lic­an Mia Love. In Alaska, Demo­crat­ic Sen. Mark Be­gich is one of the GOP’s top tar­gets.

The ef­fect on cov­er­age can be dra­mat­ic. At the end of Septem­ber, read­ers of Ari­zona’s largest news­pa­per awoke to a front-page, above-the-fold story — in print and on­line — tout­ing low prices avail­able on the state’s new in­sur­ance ex­changes: “Ari­zon­ans’ costs low un­der new health law.”

A few days later, when the ex­changes ac­tu­ally opened, the Arkan­sas Demo­crat-Gaz­ette and loc­al TV had more un­wel­come, if early, news for Sen. Mark Pry­or, a Demo­crat who has staunchly de­fen­ded the law. A state in­sur­ance spokes­per­son said that Web is­sues had, to her know­ledge, pre­ven­ted any­one from sign­ing up for health in­sur­ance in the first two days of the ex­change, a prob­lem plaguing oth­er states with fed­er­ally run ex­changes. A few days earli­er, Obama­care’s ex­pens­ive premi­um rates in the state made the Demo­crat-Gaz­ette‘s front page — right next to an ad­ja­cent story fea­tur­ing an enorm­ous pho­to­graph of a train wreck, Re­pub­lic­ans’ fa­vor­ite meta­phor for the law.

Re­pub­lic­ans in­sist the health care law’s na­tion­al un­pop­ular­ity makes it a polit­ic­al win­ner. They have a point: Obama­care’s pop­ular­ity is at an all-time low in many sur­veys. And a prob­lem-filled rol­lout of the state-based ex­changes, a glitch-fest that has left no state un­scathed, has re­newed GOP hopes that im­ple­ment­a­tion will be the kind of the kind of dis­aster that will sink Demo­crat­ic can­did­ates every­where.

Per­haps, but such con­fid­ence be­lies the sig­ni­fic­ant changes to the law’s polit­ics already afoot. A na­tion­al strategy worked in 2010 and 2012. In 2014, it likely won’t be enough.

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