The Affordable Care Act has survived yet another effort to snuff it out. And one reason is a simple reality that Republicans have rarely been willing to admit ― to their supporters, to the general public, and perhaps even to themselves.
It turns out “Obamacare” has made life better for a great many people.
Millions of Americans now have health insurance because the law has put it within financial reach. They are enrolling in Medicaid, or buying private insurance with the help of tax credits ― and taking advantage of laws that prohibit insurers from denying coverage because of pre-existing conditions. Millions more have insurance that is cheaper, better, or more comprehensive than what they could get before. They are more financially secure, they have better access to care, and they are probably getting healthier, too.
They are people like Maryann Hammers, who has stage 3 ovarian cancer and depends on her Covered California policy to pay for her care ― without fear of hitting an annual or lifetime limit on benefits. They are people like Claire and Allen Secrist, in North Carolina, who can afford the comprehensive insurance they need for a series of ongoing health issues because of the tax credits they get through healthcare.gov. They are people like Precious Young, of Los Angeles, who now qualifies for Medicaid and depends on it to pay for her psychiatric medication.
They do not account for the totality of the Affordable Care Act’s impact. The health care law has treated some people well and some people poorly. And if it is working well in some parts of the country, like California, it is not working well in others, like Tennessee. Millions of people aren’t happy with their coverage ― with the premiums and deductibles that seem too high, and the physician networks that seem too small. And as plans have pulled out of markets, because of losses, many of these people have watched nervously to see whether they’d have any insurance options at all.
Over the last few years and especially over the last few months, Republicans have shone a spotlight on these people to highlight everything that has gone wrong with the 2010 health care law. In just the past week, President Donald Trump presided at an event with Obamacare “victims” who had lost access to physicians ― and Vice President Mike Pence, speaking in Ohio, told the story of small business owners struggling to pay coverage costs for employees.
But they spoke as if these stories were emblematic of the law’s full impact, calling it a “nightmare” (Pence’s preferred term) and a “disaster” (Trump’s favorite). “Obamacare has wreaked havoc on the lives of innocent, hardworking Americans,” Trump said at that event. “Obamacare is death.” All week long, Senate Republicans made the same argument. “Obamacare’s years-long lurch toward total collapse is nearing a seemingly inevitable conclusion — and it will hurt even more Americans on the way down,” Senate Majority Leader Mitch McConnell said on Tuesday. “We have a duty to act.”
At the time, it looked as if he and his allies might succeed ― much as it did back in November and December, after Trump won the presidential election and GOP leaders were promising a quick, decisive strike against the law. But then something unexpected happened. All those people benefiting from the health care law ― and their friends and families and allies in the progressive organizing community ― began speaking out. They showed up at town hall meetings and at congressional offices. They made calls and made posters and sent a whole lot of tweets.
Republicans couldn’t ignore these voices, because they were coming from their districts and their states. They promised not to “pull out the rug” from under people with Medicaid, or to take away protections for people with pre-existing conditions. But that is precisely what their plans called for doing. One plan the Senate considered would have reduced the number of people with coverage by 22 million, the Congressional Budget Office determined, another by 32 million and yet another ― the one that failed early Friday morning ― by 16 million. Those numbers provided critics with a devastating rhetorical weapon.
What happens next is unclear. Republicans had already tried and failed this year to pass repeal ― in the House of Representatives, in March. Two months later, they tried again and succeeded. The Senate bill fell by one solitary vote on Friday, and it’s not far-fetched to imagine that GOP leaders will find a way to try again.
But it seems more likely the focus will shift back to undermining the law from within, through a combination of neglect and sabotage. The Trump administration has been cutting back on outreach efforts for enrollment. It still has not committed to paying “cost-sharing subsidies” to insurers, and media accounts suggest Trump personally wants to cut them off.
But on Capitol Hill, at least some Republican senators seem interested in starting a more routine, bipartisan discussion over how to address the very real problems with the Affordable Care Act. Sen. John McCain (R-Ariz.), who provided a dramatic and pivotal vote against repeal on Friday, has urged bipartisanship. So have the two other Republican senators who broke ranks, Susan Collins of Maine and Lisa Murkowski of Alaska. Sen. Lamar Alexander (R-Tenn.), who chairs the Health, Education, Labor and Pensions Committee, has already announced he intends to hold hearings on problems in the newly regulated markets ― and how to fix them.
Democrats, in turn, have signaled they like the idea, too. And it’s not just the centrists, like Sen. Joe Manchin of West Virginia, who are eager to start talks. Sen. Bernie Sanders, the Vermont independent and former Democratic presidential hopeful, says he wants to be a part of them too. The reality is that most Democrats and progressives have understood, from the beginning, that the 2010 health care law would be a work in progress.
If there’s now a chance to make some specific policy concessions to Republicans in exchange for bolstering the program as a whole, odds are good Democrats will take it. It’s easy to imagine a conversation, going forward, about helping the people Obamacare hurt ― just so long as it doesn’t also require hurting the people Obamacare helped.