Since Barack Obama signed his signature legislation, the Affordable Care Act (ACA), into law on March 23, 2010, Republicans have made its repeal the galvanizing cause of their party. Ever since, relentless scrutiny of the ACA (also known as Obamacare) has kept healthcare at the forefront of public policy debates. Media sources have presented endless, often only loosely factual, debate on the subject, and have fanned the flames of intense polarization about the merits of the law.
Republicans successfully distilled the complex reality of healthcare policy, villainizing the ACA with the skill of the puppeteer that presented distorted shadows as reality in Socrates’ famed “Allegory of the Cave.” Their arguments may be sophistry (to invoke another Socratic metaphor), but the spoils of electoral success are undoubted; the backlash over the ACA let the Republicans reclaim House majority status in 2010.
Yet, running in opposition is much easier than governing. And now, the Republican faithful are looking to their members of Congress to follow through on their prolonged campaign promises. But as many are quickly realizing, the plan to repeal Obamacare piecemeal is doomed. Repealing the individual mandate, while keeping the hugely popular provision that prevents healthcare companies from denying coverage to patients because of pre-existing conditions, would send the insurance market into a death spiral from adverse selection. This means that insurers would be unable to adequately support the growing percentage of plan holders who require, on average, more assistance from insurance, since they would be operating without the monthly fees paid by healthy individuals compelled by the mandate to buy insurance. These healthy plan holders, often young people, are crucial as they contribute more money to the collective insurance pool than they take out.
In addition to practical concerns, there are also political ones: According to Real Clear Politics’ poll aggregation, Obamacare is achieving its highest levels of support since its inception.
Republicans, understanding this, are now easing their language on the ACA. “Repeal and replace” has in part come to mean “officially repeal, but keep around until there is a replacement.” Additionally, a growing contingent is retreating to the gimmick of solely “reforming” the Act. What was for so long promised to be a quick repeal and replace for Republicans, who have full control of government, could now, according to Trump, take until “sometime into next year.” I doubt it will ever happen.
What Republicans also failed to take into consideration is the strengthening movement inside progressive circles pushing for a government-run healthcare system that would increase the scope of the ACA. Many progressives have their own criticism of the ACA–chiefly, that the Act did not go far enough.
The Obamacare question has permeated elections at all levels of government for the past seven years. Healthcare remains at the forefront of the American political conscious, with a recent Pew poll finding that 66 percent of Americans consider it a top political priority. Savvy Democratic politicians have exploited this opportunity to rally their base and propound a sweeping vision of the government’s role in American healthcare, one considerably more expansive than that offered by the ACA.
Throughout and following his campaign, Senator Bernie Sanders championed the option of a Medicare-for-All program as a tangible system of healthcare. His electoral success pushed the DNC to incorporate parts of his policy into its platform, the most progressive one that the Party has ever produced, even though Medicare-for-All was too radical a notion for Democratic Party to embrace in its platform.
I was particularly struck by last week’s CNN-moderated town hall debate between Senators Bernie Sanders and Ted Cruz titled “On the Future of Obamacare,” as an example of the shift in public opinion and in the Democratic Party platform.
At one point, Sanders delivered an eloquent rationale for his Medicare-for-All program. The questions segment began with LaRonda Hunter, a hair stylist who owns five salons in Fort Worth, Texas, who voiced her beliefs regarding the ACA and how the policy has limited her ability to grow as a small business. Because of the ACA’s provision requiring businesses to provide healthcare if they employ over 50 people, Hunter felt that the ACA was impeding her ability to grow as a small business. Though Sanders initially rebuked Hunter for not providing healthcare to her employees, it was the following interaction that was significant.
Sanders continued: “The situation you’ve described is honestly absurd. You should not be going around without health insurance. Your employees should not be going around without health insurance. (…) Please join me and fight for a Medicare-for-All program.” He then asked Hunter, “Are you looking forward maybe when you get to 65 to get Medicare? Would that be of help to your family?” To which Hunter responded, “I expect that that will probably happen.”
The prominence of this debate is largely due to Republican efforts to repeal the ACA—efforts that I am quite sure will fail. And not only will it fail, but progressives are also benefiting from it. As shown by this interaction during the town hall, the public is beginning to view the sense in Sanders’ argument. At the very least, the Medicare-for-All plan has moved from fringe idea to mainstream thought among the Democratic base—though, not yet at the top of the platform, as the Democratic Party has been reluctant to embrace expansive policy goals (often to its own detriment).
If Republicans had not continued their frenzy over the ACA, perhaps Democrats would have been more complacent in leaving healthcare alone, at the compromise that Obamacare represents. There are an enormous number of pressing policy issues in the United States right now. American politics is also a slow-moving machine; policy advancement chugs along a snail’s pace. But we have, possibly without precedent, remained on one policy area, one piece of legislation, for nearly a decade.
There is little hope that Donald Trump will show any willingness to collaborate with Democrats on passing a public option, though Trump did pledge “insurance for everybody” in a recent interview with the Washington Post. However, come 2020 when Democrats draft their new platform, expect a newfound vision for a public option or, depending on the nominee, possibly even a Medicare-for-All program. Both would constitute a gigantic progressive leap in policy compared to the 2016 platform. And Republicans only have themselves to blame for this.