Are Republicans Abandoning Opposition to Obamacare?


Gage Skidmore Flickr (CC BY-SA 2.0)

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.