Since the end of the initial open enrollment period, there has been a marked rise in the frequency of a certain type of argument – an argument which I hear with regularity inside the Acela corridor, but almost never outside of it. The argument goes something like this: regardless of the political toxicity of Obamacare, it is here to stay, and the laws opponents and Congressional Republicans need to wake up to that fact, or else.
The “or else” could be anything, and is essentially interchangeable. The most common prediction is of electoral doom; less so are predictions of revolutionary protests in the streets, turning to violence in defense of their Medicaid benefits, or losing broad swathes of traditionally red states in the Senate contests this year, or most recently, a prediction that Republicans will lose 90 percent of women voters in 2016. And yes, I’ve heard all of these and more in recent weeks.
This argument has a milder version which is repeated in the more sensible press. These observers concede that yes, Obamacare is still very unpopular, and yes, premiums are still going up, and yes, it’s signed up fewer uninsured than we expected and even those newly insured are barely favorable of it… but still, they insist, talk of repeal and replace is just politicians irresponsibly playing to the more radical elements of their conservative base. Forget the polls – Obamacare is here to stay.
I think this is a mistaken view of the political realities at play here. Perhaps this is driven by the drumbeat of “good news, everyone” which has been put forward by supporters of the law. But in an era when wonks are so plentiful, data journalists fall fully ripened from the trees, and explainers flower with the glorious frequency of endless summer, it’s easy to lose sight of the simplicity of factors which will determine whether policies maintain their permanence or are dramatically reformed.
It’s a mistake to assume there is a magic number, a point of uninsured who gained insurance, a statistic of Medicaid signups, or a percentage of average premium increases which will mark the point where Obamacare is safe from Republican assault. The average American voter and policymaker is not watching these factors – they are aware of Obamacare’s performance primarily through how it impacts their livelihoods, costs, and constituents. The opponents of the law are far louder and more motivated than its supporters. And that is very unlikely to change any time soon.
This is why I do not understand the assumptions of inevitability on the part of the law’s supporters. The Republican Party has put the repeal of President Obama’s signature law at the center of its agenda for years. It has taken repeal vote after repeal vote and made pledge after pledge. As a matter of partisan priority, there is nothing greater. And one more year of Obamacare will not change that.
Every single feasible candidate for the 2016 Republican nomination will loudly declare their support for repealing the law. Most will also offer a policy replacement, culled from the various technocratic and free market think tanks or from the legislation currently introduced in Congress. Whoever Republicans choose as their nominee, their favored replacement will become the de facto alternative Republican plan which party leaders and elected officials will all be expected to defend. And should the Republican candidate win, it is inconceivable that they will not have run on making the replacement of Obamacare a top priority for the first 100 days in office.
Republicans are not going to back off their efforts for repeal. It is a top priority for their national base, for their donors, and for their constituents. If Republicans have the Senate, it becomes that much easier – but even without it, the margin will be narrow, and the possibility for dealmaking outranks the likelihood that every single Democratic Senator will toe the line and pass on the opportunity to help remake health policy as they see fit. And while the election of Hillary Clinton or another Democrat would prevent this circumstance and protect Obamacare from assault, assuming that such an election is inevitable is really what you’re saying when you say Obamacare is here to stay.
The political legacy of Obamacare and the 2012 election is a vindication of monopartisan governance. Great domestic policies are no longer achieved via bipartisan give and take or the leadership of careful compromisers – they are rammed through with the support of your party and your base when you have the power to do so. I fully expect to see Republicans attempt to do that should they retake the White House.
So what are we to do in the time until November 2016? Well, in the meantime, we can discuss the other factors and outcomes of this policy in the ways they impact America’s insurers, hospitals, drugmakers, and industries. But we should not lose sight of the fact that it is this political outcome, and this outcome alone, which will determine whether Obamacare survives or not. It’s just not that complicated.