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Have Republicans Given Up In The Fight Against Obamacare?

Healthcare Gov

For five years, the Affordable Care Act, or “Obamacare” to use a word first coined by critics of the plan to reform health care coverage that has now been adopted by those who favor the plan, has been at the center of Republican attacks against the President. Before the ink was even dry on the law in March 2010, Republican politicians and conservative pundits set their sights on the law and used it to help fuel the political movement that vaulted the GOP in to control of the House in November of that year. Once they had control of one chamber of Congress, Republicans engaged in repeated efforts to try to repeal the law that would always end up dying the Senate. By the time the 112th Congress came to an end, in fact, the House had voted to repeal all or part of the law more than fifty times, and additional efforts would be made during the 113th Congress as well. During the 2012 campaign, Republicans were convinced that public opposition to the law would play a big role in unseating President Obama, even though they nominated the man who had signed a remarkably similar law into effect when he was Governor of Massachusetts. Even after losing the election, Republicans continued their efforts to attack the law, and in October 2013 they went as far to shut the government down in what turned out to be a doomed effort to “defund” the law. Meanwhile, the law itself went into effect and, while implementation has been rocky and their have been reports of increased costs and premiums, for the most part it appears that the forecasts of doom made by many critics have not come to pass, at least not so far.

Outside of the political world, the ACA also came under attack in the courts as numerous states and private defendants filed lawsuits alleging that the law was unconstitutional, specifically with regard to its requirement that all Americans who aren’t covered by an employer-provided plan either purchase insurance or pay a fine that was imposed via the Internal Revenue Service. Several of those lawsuits succeeded at the lower court level, including at the 11th Circuit Court of Appeals and there were many on the right who hope that the Supreme Court would follow those precedents and strike the law down. In June 2012, though, a closely divided Court upheld the law as a proper exercise of Congress’s power not under the Commerce Clause as many anticipated, but under the Taxation Clause. In later years, the law has faced challenges related to requirements that employers cover contraceptives in insurance plans provided to employees, the system used to control health care costs, and, most recently, the subsidies provided to consumers based on their income. While some of these challenges have been successful, none of them attacks the core of the law the way that the original lawsuit did.

Now, as we head into the 2016 Presidential election The Los Angeles Times’ Noam Levey notes that Republicans have largely abandoned their efforts to take the law down:

After five years and more than 50 votes in Congress, the Republican campaign to repeal the Affordable Care Act is essentially over.

GOP congressional leaders, unable to roll back the law while President Obama remains in office and unwilling to again threaten a government shutdown to pressure him, are focused on other issues, including trade and tax reform.

Less noted, senior Republican lawmakers have quietly incorporated many of the law’s key protections into their own proposals, including guaranteeing coverage and providing government assistance to help consumers purchase insurance.

And although the law remains very unpopular with GOP voters, more than 20 million Americans now depend on it for health benefits, making even some of the most conservative Republicans loath to cut off coverage.

Facing the prospect that the Supreme Court this year could strip away insurance subsidies provided through the law in most states, several GOP lawmakers have proposed extending the aid, perhaps even until a new president takes office.

At the same time, the presumed Republican presidential front-runner, former Florida Gov. Jeb Bush, has shown little enthusiasm for a new healthcare fight. Last year, he even criticized the repeal effort.

Republicans who still demand a repeal, including Sen. Ted Cruz of Texas and Louisiana Gov. Bobby Jindal, appear to be long shots for the presidential nomination.

“Only 18% of Americans want to go back to the system we had before because they do not want to go back to some of the problems we had,” Whit Ayres, a veteran Republican pollster who works for presidential candidate Sen. Marco Rubio of Florida, said at a recent breakfast hosted by the Christian Science Monitor.

“Smart Republicans in this area get that,” he added.

These developments have sapped enthusiasm among Republican leaders for “pulling out Obamacare root and branch,” as Senate Majority Leader Mitch McConnell (R-Ky.) once put it.

Instead of trying to repeal the PPACA, many of the central parts of the law are now part of health care reform ideas being put forward by Republicans on Capitol Hill:

No longer is the party proposing to overhaul the employer-based system that most Americans rely on for health benefits, as Sen. John McCain (R-Ariz.) did when he was the presidential nominee in 2008.

Nor are party leaders pushing plans that don’t meaningfully expand coverage, as House Republicans did in 2009.

In fact, the most fully developed GOP healthcare plan at the moment not only preserves the employer system, it essentially keeps many provisions of the Affordable Care Act, though sometimes in a different form.

The proposal — by Sen. Richard M. Burr (R-N.C.), Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) and House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) — would guarantee coverage to Americans even if they are sick, a protection that was a watershed when it was enacted in the 2010 law.

The Republican outline would ban insurance companies from imposing lifetime limits on coverage, allow young adults up to age 26 to remain on their parents’ health plans, and create a system of tax subsidies to help Americans buy coverage. All are pillars of the current law.

Like the current law, the proposal includes a system for penalizing people who don’t have health insurance, although the mechanism is different than the current tax penalty.

And the Republican plan, like the current law, relies on cuts in Medicare spending and a new tax on employer-provided health plans with particularly rich benefits.

“This acknowledges that the ACA is the law and … you have to start with what is there and build on it,” said former Utah Gov. Mike Leavitt, who served as Health and Human Services secretary in the last Bush administration. “The recipe is to begin pushing it philosophically to the right.”

One indication of how things have changed inside the GOP regarding the law can be seen in how many Republicans are reacting to the possibility of a Supreme Court decision later this year in a case that could cause serious problems for many of the Americans who have purchased insurance under the law. In that case, King v. Burwell, the Court is being asked to determine whether the language in the law allows for subsidies to be paid to consumers regardless of whether they purchase insurance on an exchange established by the Federal Government, or one established by individual states. The Plaintiffs in that case, of course, have argued that the language of the law, as written, only authorizes subsidies for insurance purchased on state exchanges and, as I’ve noted, it is a persuasive argument. If the Court rules for the Plaintiffs, then it would potentially mean that millions of people who have purchased insurance on the federal exchange would suddenly lose their subsidies and be forced to either pay substantially higher premiums, or lose their insurance. In response, several Republicans on Capitol Hill are proposing legislation that would allow the subsidies to continue for 18 months or more to give Congress time to come up with a solution. This is markedly different from attitudes expressed by politicians on the right in the past, which can essentially be summed up by the phrase “let it burn.”

Part of what’s happening here, of course, is a recognition of political reality. Even with Republicans controlling both the House and the Senate, a bill to repeal the Affordable Care Act would never become law as long as Barack Obama is President. Even if the GOP wins the White House in 2016 and holds on to to Congress, Democrats in the Senate would be able to use the filibuster and other parliamentary procedures to block efforts to repeal the law. Additionally, even taking into account the fact that the Affordable Care Act remains unpopular according to the polls, there seems to be little support for repealing the law in its entirety and returning to the status quo that existed before  2009. This seems to be especially true regarding aspects of the law that are popular on their own, such as the bar on denying coverage for pre-existing conditions, the elimination of the lifetime cap on coverage, and the rules that allow parents to keep their children on their policies until they are as old as 26. Additionally, as I noted prior to the 2014 elections, while the initial roll out of the law was nothing short of a disaster, the news since then regarding the law has been generally positive. For example, recently Gallup reported that the percentage of Americans who were uninsured had fallen to its lowest level since they began tracking that statistic in 2008. To supporters of the law, of course, this is an indication that the law is working. For the average Americans, news like this likely tends to reduce some of the doubts about the law that were allowed to fester during the three year period before it actually went into effect. Given all of this, it isn’t entirely surprising that Republicans are, for the most part, scaling back on their rhetoric regarding the law and looking at ways to reform the law through the legislative process rather than repealing it completely as they tried many, many times after taking control of Congress.

None of this is to suggest, of course, that Republicans have suddenly become fans of the Affordable Care Act. You’re still going to hear candidates for Presidents criticizing the law on the campaign trail, for example, and some of them will still be talking about wholesale repeal. Additionally, the political battles over some of the reform ideas being batted around by Congressional Republicans are likely to be just as contentious as the battle over the Affordable Care Act itself. At the same time, though, it’s rather clear that the GOP has changed its tune on the Affordable Care Act and that, while there will be efforts to reform the law, in some cases in fundamental ways, the basic structure of the law has become so embedded in the economy now that the chances it will ever be repealed in toto are fairly low.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. michael reynolds says:

    Asking people whether they like health insurance is insane. I have car insurance. Do I love it? Um. . . who loves insurance? I have life insurance . . . not emotionally committed to it.

    Health insurance is a system where you pay money so that when you get seriously ill and doctors are chopping off various body parts you won’t go broke. Which part of that is likely to fill a person with joy? Thinking about pain and death? Thinking about paying for pain and death?

    Gosh, I love the fact that when I get a brain tumor it will be paid for! I’m so looking forward to that!

    The metric is not popularity. Health insurance is broccoli, no one’s ever crazy about it.

    The question is, does Obamacare perform as advertised? And the answer is Yes.

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  2. Moosebreath says:

    Uh-huh. Get back to me when the Republicans are willing to work with the President to improve Obamacare, adding necessary changes (including the one which would cure the silly claims in the pending case before the Supreme Court), even in exchange for getting something they want. Until then, they are biding their time, not giving up the fight.

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  3. @michael reynolds:

    Health insurance is broccoli, no one’s ever crazy about it.

    I am… I love broccoli.

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  4. Modulo Myself says:

    The plaintiffs’ argument isn’t remotely persuasive in King. The best they have is a law that somewhat contradicts itself. There’s no evidence in the ACA (or outside of it) that any exchange was intended to provide insurance without a subsidy. So the burden of interpreting the law falls on the agency who administrates it. But the plaintiffs seem to be arguing that the ACA is so CRAZY as a law that normal rules don’t apply, or something.

    Also, it’s grasping to think that a few Republicans proposing legislation equals doing something about providing subsidies. If the court rules in favor of the plaintiffs, Republicans are going to nuts trying to punish Obama for the ACA’s success. It’s going to a debacle, and the weirdos who populate the GOP world will buy into it.

    “Why shouldn’t the Democrats forfeit the next election in return for federal exchanges offering subsidies? Obama essentially did something similar by winning an election. The problem lies in both sides and we need a solution that eliminates partisanship.”

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  5. stonetools says:

    Nothing succeeds like success, and the ACA is a success. that’s becoming clearer month by month, despite relentless right wing propaganda to the contrary.
    Heck, we can see this in Doug Mataconis’ evolution on this. Doug started out viscerally opposed to the ACA and frequently quoted tweets from a right wing organization called UnitedLiberty.org, who predicted unconditional disaster for the ACA. They are still doing it, but Doug has stopped retweeting them. The reason is that (to his credit) he has considered the evidence, and has decided the ACA is a qualified success.
    The same realization is creeping into the heads of Republican politicians, who are realizing that opposing a successful and increasingly popular social insurance program might be politically damaging in 2016.
    Consider Senator Ron Johnson (likely to face a tough challenge in 2016):

    In a little-noticed radio interview, Sen. Ron Johnson (R-WI) articulated the GOP’s biggest fear if the Supreme Court wipes out Obamacare tax credits for millions of Americans who buy insurance from the federal HealthCare.gov exchange.

    The fear: President Barack Obama and Democrats will be ready with a one-page bill to restore the subsidies, as well as a slew of attack ads telling horror stories about “individuals that have benefited from Obamacare on the backs of the American taxpayer” and lost their coverage, the Republican said.

    Here’s the transcript from the April 14 interview radio interview, in which Johnson is asked a question by host Jay Weber about King v. Burwell.

    JOHNSON: Unfortunately, President Obama’s response to an adverse decision — in other words one that actually follows the law — would be really simple. Just a one-sentence bill allowing people’s subsidies to flow to federal exchanges and/or offer the governors, ‘Hey, we know you got those federal exchanges. Just sign the bottom line. We’ll make those established by the state.’ And of course, he’ll have the ads all racked up with the individuals that have benefited from Obamacare on the backs of the American taxpayer. He’ll have all those examples as well so…
    WEBER: And the sad sack stories about who’s dying from what and why they can’t get their coverage.
    JOHNSON: Right.

    I think a lot of Republicans are secretly hoping that SCOTUS doesn’t find the plaintiffs persuasive in Burwell.

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  6. John O says:

    @Modulo Myself: Do you not know who Johnathan Gruber is? Plaintiffs argument is persuasive:

    Here’s what Gruber said (and there’s video at the link):

    What’s important to remember politically about this is if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this.

    The whole point was to coerce the states to set up the exchanges, and the consequences were supposed to be dire. That was the point. Now, the courts are asked to read the statute not to result in those consequences because they’re unthinkably harsh. Congress couldn’t have meant that.

    Exactly.

    Lost in the King v Burwell discussion: Employers in states that refused to set up Obamacare exchanges would be exempt from the employer mandate because no federal outlays would be made to trigger the penalty.

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  7. John O says:

    @stonetools: I think a lot of Republicans are secretly hoping that SCOTUS doesn’t find the plaintiffs persuasive in Burwell

    Agreed. As with much else the federal government does the ACA shifts the politics of health care to the left; Republican politicians are largely happy with this. Their constituents? Not so much.

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  8. Modulo Myself says:

    @John O:

    The real crime with Gruber was that he was paid 250K. But he was paid for the use of his models. He was not involved with legislation. Anyway, what he said totally wrong. People who actually believe that the federal exchanges were designed to operate without mandates are idiots. People who want to use Gruber’s quote to take away the subsidy are dishonest.

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  9. JohnMcC says:

    For those who have not yet seen it, here’s the self-recorded lament of a Mr James Webb on his youtube channel “hot lead”. Our Mr Webb who professes to be a life-long Repub & a co-founder of his local Tea-Party-Patriots is lamenting that his party hasn’t done anything for him since the golden days of the magnificent Ronald Reagan and that if Obamacare is repealed, he’ll have to “GO BACK TO WORK.” Access to the health insurance market allowed him to retire; Obamacare even reimburses him for his gym membership. He’s probably going to vote for Hillary.

    http://www.youtube.com/watch?v=tNfo0o7ay7A

    I would say ‘yeah, Repubs have given up on this fight and for good reason; they lost this fight.’

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  10. Modulo Myself says:

    @stonetools:

    That’s a real charming interview. The losers who are all out there dying or whatever it is that losers who don’t have employer health care do are inconsequential, it seems, but occasionally, PR for the losers may hurt the GOP brand.

    This is stuff that used to be said behind closed doors by intelligent and cynical people paid money to deliver results. It was not really the basis of an ideology.

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  11. gVOR08 says:

    “Obamacare” to use a word first coined by critics of the plan to reform health care coverage that has now been adopted by those who favor the plan

    Obama embraced the term. Turns out once again he could see the future more clearly than the Republicans. But then who can’t?

    In twenty years GOPs will be claiming they created Obamacare. Of course they’ll have to come up with a new name for it. Maybe Boehner Care. At least the jokes would be appropriate.

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  12. stonetools says:

    @John O:

    If you were honest about debating this, you would also admit the Gruber has many times said the quoted statement was a misstatement

    Among those who say they are surprised by the statement is Gruber himself, whom I was able to reach by phone. “I honestly don’t remember why I said that,” he said, attempting to reconstruct what he might have been thinking at the time. “I was speaking off-the-cuff. It was just a mistake.” As evidence that it was not indicative of his beliefs, he noted that his projections of the law’s impact have always assumed that all eligible people would get subsides, even though, he said, he did not assume all states would choose to run their own marketplaces.

    Now its important to understand that it was his WORK in 2010 and prior that the ACA was based on-not whatever he might have said in his attempts to gin up support for the ACA in 2012. If you were honest, you would admit this. But of course., like every right winger who supports this misbegotten lawsuit, you are being completely dishonest.

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  13. stonetools says:

    @Modulo Myself:

    Essentially, the interview makes clear what has been true from the beginning-that the ACA opponents are a$$holes who opposed it for purely political reasons, indifferent to the sufferings of millions of uninsured Americans. One such a$$hole has showed up on the thread, and I’m sure he is in fully agreement with Senator Sociopath.

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  14. michael reynolds says:

    @stonetools:
    Obamacare always had Republican DNA. The GOP didn’t oppose it for any reason other than a desperate need to deprive Mr. Obama of a success.

    Throughout the last six years hatred of Mr. Obama has driven virtually everything the GOP did or attempted. They will actively harm the country in order to harm Obama. That’s all it took to blow away Republican patriotism: put a black man in the White House.

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  15. Tyrell says:

    “Stupidity of the American voter” (Jonathan Gruber)
    One problem is that millions have now been hit with a double whammy: they don’t qualify for a subsidy but can’t afford high medical insurance premiums: now they are being hit by the IRS with a fine, fee, tax, or whatever Judge Roberts calls it. That is no way to treat the American citizens, Mr. President !
    “Stupidity of the American voter” (Jonathan Gruber)
    “We have to pass it so we can find out what’s in it” (Nancy Pelosi)

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  16. al-Ameda says:

    @michael reynolds:

    Obamacare always had Republican DNA. The GOP didn’t oppose it for any reason other than a desperate need to deprive Mr. Obama of a success.

    Throughout the last six years hatred of Mr. Obama has driven virtually everything the GOP did or attempted. They will actively harm the country in order to harm Obama. That’s all it took to blow away Republican patriotism: put a black man in the White House.

    Exactly right – dead on.

    @Tyrell: “Stupidity of the American voter” (Jonathan Gruber)

    We know this because the American voter has now given control of Congress to the Republican Party.

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  17. Larry T says:

    @James P:

    down our throats

    Is right! Thats what Hitlery will try to is ram things down our throtes. And thats what her husband did but to interns.

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  18. David M says:

    It is worth noting that it’s now been over four years that the GOP hasn’t had an alternative to Obamacare, not counting the two years before that when Obamacare was being debated and passed. I think it’s pretty clear they aren’t capable of that level of complex policy development until something drastic changes.

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  19. Larry T says:

    @James P:
    But I’m not sure about race-batting. Is that like Jackie Robertson?

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  20. al-Ameda says:

    @Larry T:

    But I’m not sure about race-batting. Is that like Jackie Robertson?

    You’re thinking of Cliff Robertson, or maybe Bob Robertson.

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  21. lounsbury says:

    Frankly I have a hard time thinking this James P with an pic of Reagan and Palin is anything but someone jerking your chains…

    Otherwise is has continued to escape me the virulence of US Republican party distaste for a national health care system when the employer based system is so very clearly a burden on private sector as a cost and a serious disadvantage for smaller firms relative to global market.

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  22. DrDaveT says:

    @michael reynolds:

    Asking people whether they like health insurance is insane.

    I have a slightly different take on this.

    When you poll people, “Obamacare” is very unpopular. “The Affordable Care Act” is somewhat unpopular. Nearly all of the individual provisions of PPACA, polled separately, are quite popular.

    ‘Nuff said.

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  23. al-Ameda says:

    @James P:

    Sure it does – it’s called the free market. IT’s called if you want health insurance buy a policy. If you don’t, then don’t. Either way it’s none of the government’s concern or business. That’s the alternative.

    And … we’ve been there and done that. It’s the reason why, from about 1995 to 2010, we experienced annual increases in the cost of health insurance of over 3-4 times the rate of inflation.

    I know this because an important part of my responsibilities has been managing health insurance contracts for business and organization’s employees. For over 15 years I received annual notifications of premium increases ranging from 10% to 22%. We constantly adjusted our plans, offered HSA and higher deductible options, increased the portion employees had to pay – most of the time to no avail. So, yes, I’m well aware of the magic of the Free Market.

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  24. Larry T says:

    @James P:

    EXACTLY! Never pay more for a heart transplant than for a old regular muffler replacement. I wish people would listen to you and they’d see you don’t even NEED doctors unless you have cash or if they take a credit card and you have one.

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  25. lounsbury says:

    @James P: And this is called superficial tripe that only trolls, extremist ideologues, and low-grade idiots engage in.

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