Are Republicans backing off their staunch opposition to
Obamacare? That’s the question raised by a Washington Post
report today on the evolving way that GOP politicians and
candidates are talking about the health law now that its coverage
expansion has gone into effect.
The Post‘s
report follows a string of stories from GOP-watchers like the
Post’s Greg Sargent, who, for the last few weeks, have
been suggesting that the Republican party is beginning to bend, at
least a little, when it comes to the health law. This suggestion
rests heavily, though not exclusively, on statements from Scott
Brown, the former GOP Senator from Massachusetts who is running for
Senate in New Hampshire, and Senate Minority Leader Mitch McConnell
(R-Ky.), who just won a GOP primary and is now set to face off
against Democratic candidate Alison Grimes in November.
As Sargent has noted, Scott Brown’s statements on the health law
have
not exactly been
crystal clear. At times, they are almost completely
indecipherable. For example, here’s what Brown
said on radio station WMUR last month when asked about how he
would approach health policy, since he thinks Obamacare is a
disaster:
“I’ve always felt that people should either get some type of
health care options, or pay for it with a nice competitive fee.
That’s all great. I believe it in my heart. In terms of
preexisting conditions, catastrophic coverage, covering kids —
whatever we want to do, we can do it. As a matter of fact, in New
Hampshire, I would encourage everybody to do a New Hampshire plan
that works for New Hamphsire, that deals with individual freedoms,
and doesn’t have mandates put on by bureaucrats in Washington….a
plan that is good for New Hampshire…can include the Medicaid
expansion folks who need that care and coverage.”
I don’t know what that means. I doubt Scott Brown knows what it
means. That’s because it probably doesn’t really mean anything,
except that Scott Brown would like to be the Republican Senator
from New Hampshire, and he will say various things about health
care if that turns out to be part of the job. Brown added to the
incoherence of his non-position position by stating, during the
same interview, that he thought that Obamacare was a “disaster” but
also that he agreed with the philosophy behind the law.
This tells us plenty about Scott Brown, but I am not sure how
revealing it is about the Republican party. Brown has always been a
policy lightweight with little interest in the minutae of
government. The most generous way to put it is that he has always
claimed to stand for the interests of his constituents more than
for any policy agenda. A less generous way to put it is that he has
never seemed very interested in policy details, and never been very
good at describing his own policy positions when pressed.
At his first news conference after winning the Massachusetts
Senate seat in 2010, for example, he dodged virtually every policy
question by
claiming a lack of sleep. I’m sure he really was tired, but
somehow he’d managed to run for Senate and win without developing
any particularly detailed positions on most major policy issues.
Win or lose, I suspect he will complete his current Senate campaign
with a similar level of effort.
A somewhat more interesting case of potential Republican
moderation on Obamacare comes from Kentucky, where Sen. Mitch
McConnell, arguably the country’s most powerful Republican has
argued that Obamacare was a “big mistake” that needs to be pulled
out “root and branch”—and also suggested that the state’s Obamacare
health exchange could perhaps be left in place.
Questioned this week about whether his desire to
completely undo Obamacare would also mean dismantling the state
exchange, he
said, “I think that’s unconnected to my comments about the
overall question here.”
This is at least half a load of nonsense: The state’s health
insurance exchange, dubbed Kynect, was created explicitly in
response to Obamacare, and was funded with
about $250 million in federal grants made possible by the law.
To the extent that Obamacare’s individual insurance market reforms
and private coverage expansion exists in Kentucky, it exists
through Kynect.
Still, it’s at least possible to imagine a future in which
Obamacare is repealed and Kentucky maintains and runs its own
health insurance exchange. That’s what Massachusetts did, with the
help of a deal to secure federal funding, and in the absence of
Obamacare, it’s conceivable that other states could negotiate
federal funding deals for their own exchanges. Yet even this
scenario suggests potential GOP support for state-run programs that
very much resemble Obamacare. (Which is maybe not that surprising
given that the Massachusetts system was, after all, passed under a
Republican governor who eventually became the GOP’s presidential
nominee.)
Do these and other episodes of GOP confusion about the law
represent a turning point in the party’s opposition to the law? I’m
not so sure. What McConnell’s awkward statements suggest is that
the Republican party has not solved its old problem when it comes
to health policy: The GOP knows clearly what it is against, but not
what it is for.
Yes, there are a handful of GOP-crafted alternative health
policy proposals in the waiting, but there’s little effort to
promote these plans or unite around them. When Republicans are
asked what they would do about health policy, they typically point
to Obamacare and say, “not that!” The law’s coverage expansion has
simply added to this problem, because Republicans, not really
knowing what they favor in health policy, have no clear idea what
to do about the people who are now receive coverage through the
law’s various provisions.
That means the GOP is an awkward spot, but it doesn’t mean they
will or should reverse course. If you look at the polls, the GOP is
on the right track.
The health law is not popular, never has been, and there’s
little indication that it is gaining in popularity now that its
coverage expansion—its biggest, most widely felt benefit—has kicked
in. Even the low-income cohort who ought to benefit most from the
law
believe that their insurance options have not improved this
year. Just
14 percent of the public thinks they’ve been helped by
Obamacare. And in perhaps the most telling sign that there’s no big
turning point in sight, House Minority Leader Nancy Pelosi says
that
Democrats won’t run on the health law this year. Republicans
may not know quite how to talk about health policy, but Democrats
aren’t exactly sounding confident about their work on it
either.
The public is clearly with Republicans in opposing the law in
its current form, and that’s why the GOP’s broad opposition is
likely to continue. Republicans don’t need to weaken their
opposition to Obamacare—they need to find something they would like
to do instead.