When the Morning Consult asked me to serve as one of the monthly columnists on healthcare issues, I had some initial doubts. I do not purport to be a health policy expert. I am no Chris Jennings or Gail Wilensky. But what I do bring to the table is some level of understanding of both the political and legislative process and the intersection between politics and health care issues and that is precisely what I hope to focus on in these columns.
In this, my inaugural effort, I want to focus on how the Affordable Care Act a.k.a. Obamacare (ACA) is playing out as we move toward the midterm elections. I suspect I may be returning to this topic more than once before November 4. Just a couple months ago it was the conventional wisdom in Washington that ACA was politically toxic for Democratic senators and House members up for reelection in November from red and purple states. To be sure a large part of the electorate clearly has major concerns about the law as has consistently been reflected in public opinion polls and this remains a defining issue to the Republican base. But I think there has been a definite shift in how politicians on both sides of the aisle are approaching the law.
Nationally on the part of Republicans there is a reduced emphasis on the repeal message. GOP leaders have shifted from pushing House floor votes calling for totally eliminating the law to floor votes that would gut individual parts of ACA (at last count there have been over 50 repeal or partial repeal votes but who is counting? ) and are dragging their feet on introducing an ACA alternative. They understandably worry that it could provide campaign fodder for Democrats. Even some of the most conservative members of the Republican caucus- like Andy Harris of Maryland- are acknowledging that major components of the law are sound policy and that full repeal doesn’t make sense. We also see this being played out in ads being run by traditional GOP allies, including the U.S. Chamber of Commerce, saying that the ACA needs to be fixed, not repealed.
And on the Democratic side, a number of senators in tough reelection bids, including Hagen, Pryor, Begich and Landrieu, are becoming increasingly comfortable talking about some of the advantages of the new law. Despite the heavy ad buys by conservative groups slamming Senator Kay Hagen for voting for ACA, she has publicly defended her vote and criticized her opponent, North Carolina Speaker Thom Tillis, for blocking in the state legislature a key feature of the law- Medicaid expansion- which could have provided coverage for 500,000 North Carolinians. “That’s just one example of Thom Tillis not understanding North Carolina and not understanding North Carolina values,” she said.” Senator Landrieu similarly criticized Louisiana Governor Bobby Jindal for opposing Medicaid expansion in that state, calling it the “Jindal gap.” Meanwhile Senator Pryor has not only defended his state’s version of the expansion of Medicaid but criticized his opponent’s vote for a bill that would change the definition of a full-time employee under ACA from 30 to 40 hours, thereby significantly reducing the number of Americans receiving employment-based coverage.
The shift we are seeing in ACA messaging from both Republicans and Democrats is due in large part to the fact that major parts of the law are very popular with voters and to the fact that the national website has been fixed and more than 12 million Americans have gained coverage either through the exchanges or Medicaid and the Children’s Health Insurance Program. Moreover, I suspect that significant segments of the public have grown weary with the repeal mantra repeatedly being mouthed by GOP leaders and have moved on to focus on weightier concerns.
This doesn’t mean that Democrats can ignore the potential for Republicans to continue to exploit this issue in individual campaigns. GOP strategists will continue to find creative ways to stoke anger among their base voters. “Repeal ACA” may no longer be front and center in broadcast ads, but will no doubt be a prime subject for direct mail, phoning and other more targeted media efforts. I don’t expect politically imperiled Democrats to launch a full-throated defense of ACA but they are increasingly comfortable about touting the law’s benefits. This may not be a sea change in the political world but it is a far cry from where we were earlier in the year.