As a perpetual optimist, I’m pretty sure this is the low point for what I consider to be the greatest victory for the middle class since Medicare/Medicaid — the Affordable Care Act.
Approval of President Obama and the law are at new lows. Still, as The Washington Post‘s Greg Sargent keeps pointing out, support for repeal is still a minority position and hasn’t changed much since the disastrous roll out of HealthCare.gov. (Obamacare is also more popular than the Republicans in Congress.)
So any polling until that happens is going to be painful.
The bad numbers and ancillary cowering by vulnerable Democrats will only intensify the Republican fixation on repeal. Here are reasons why this is a good thing:
1. About 500,000 people have already signed up for coverage through an ACA-related exchange.
These are people whose insurance will be taken away in case of a repeal. And unlike the millions of people who have received so-called “cancellations,” these people would be thrown into a pre-Obamacare world, where many of them won’t be able to find coverage. And the coverage they can find may still leave them exposed to huge financial risk.
2. As many as 12 million people are going to find out they’re eligible for completely subsidized or almost completely subsidized coverage.
That’s about 5 million who can receive Medicaid expansion, along with a large number of others who will discover they’re eligible for Medicaid, plus another 7 million who could end up with free Bronze-level plans, which aren’t the best option but are far better than nothing. Repeal rips health insurance away from all these people. It also erases the subsidies that will help another 10 million or so pay for some part of their coverage. As the websites get better, hopefully, these people, along with their family and friends, will discover that this law is life-changing and possibly even life-saving.
3. The vast majority of Americans will feel no significant change from the law.
Fox News is trying to scare people with employer-provided insurance that they have to be afraid of Obamacare. While any changes in policies will surely be blamed on the ACA, there just won’t be that many. Coverage will be stronger, provide more benefits and now cover mental health. After January 1st, the fear of the unknown will transition from the ACA to the murkiness of repeal.
4. The insurance industry wants to make this work.
I’m in favor of single-payer or, at least, a public option. Any argument that relies on the generosity of private insurers makes me queasy and self-hating. But one of the huge compromises that made this law possible is that it engaged the industry and built fail-safes to keep rates low for the first few years. In exchange, we got the greatest public policy attack on inequality in generations by expanding Medicaid and awarding subsidies to the vast majority of the middle class. The scale of this reform is so huge that even with new regulations that force them to spend 80-85 percent on care, the insurance industry will do everything it can to make this law work.
5. It’s never ever going to happen.
Unless it’s technologically impossible to make Healthcare.gov work, President Obama is never going to get rid of the Affordable Care Act — probably not even then. That means you need 2/3 of the House and the Senate to vote to make that happen. By continually promising repeal, Republicans may create another Roe v. Wade for their activists to oppose while cornering themselves into an increasingly untenable position that might actually force them to vote on an Obamacare replacement, which will undoubtedly cancel more insurance policies than the ACA ever could.