Since the Affordable Care Act was adopted, the tectonic plates of health care politics look like they’re shifting.
Rep. Bruce Poliquin hasn’t even been in office five months, and already his positions on the Affordable Care Act (Obamacare) have moved enough to make several flip-flop-themed campaign ads.
Poliquin attacked primary opponent Kevin Raye for being insufficiently anti-Obamacare. During the general election campaign, Poliquin consistently stated he wanted to repeal and replace the law.
But when faced with a vote to repeal it, Poliquin voted “no,” explaining he didn’t want to leave over 60,000 Mainers in a lurch.
Then, in supporting the House’s budget, with its provisions to defund Obamacare while counting as revenue money generated by the law, Poliquin voted to cut the funding for the subsidies he had come to want to protect in the absence of an alternative. This budget also partially privatized Medicare, raised military spending and slashed domestic spending.
Why has Poliquin gone from supporting repeal, to voting against repeal, to voting to block the money the program needs?
Republicans still strongly dislike Obamacare, and supporting the law might cause political problems in 2016 congressional primaries.
However, among the general electorate, repeal remains unpopular. While most polls have shown less approval than disapproval, in part that’s because some who disagree with the law want a more expansive policy. Let’s not forget that the pro-health reform presidential candidate, Barack Obama, won two electoral vote landslides.
In the latest monthly survey by the nonpartisan Kaiser Family Foundation, dislike for the law still outpolls liking it, but the gap is down to just two percentage points. More telling, only 30 percent support repeal, with another 10 percent wanting the law scaled back. Compared with that 40 percent of the public, 46 percent either want the law implemented as is (23 percent) or expanded (23 percent).
A recent Washington Post-ABC News poll found 45 percent said they would rather vote for a 2016 presidential candidate who wants to repeal the ACA, compared with 49 percent who would favor a candidate who wants to keep it.
It used to be that people who dislike the law and favor repeal felt more intensely than the people who like the law.
Intensity is now a little less less among those who want a presidential candidate seeking repeal; 74 percent of this group see this position as extremely or very important. In contrast, 76 percent of people who favor a candidate who would retain Obamacare thought that was extremely or very important.
What may really trouble anti-ACA politicians is that subsidies for private insurance are really, really popular — including among Republicans.
People think there will be grave damage if the Supreme Court rules that Americans in states using the federal health insurance exchange can’t get subsidies.
According to the Kaiser poll, 62 percent overall and majorities of Democrats, independents and Republicans think a ruling against such subsidies would hurt the country.
While Gov. Paul LePage and other Maine Medicaid expansion opponents told potential enrollees they should use the federal exchange to get subsidized coverage, they haven’t said what they would do if the Supreme Court throws out those subsidies.
As Gov. Scott Walker, R-Wisconsin, acknowledged, Republican governors who haven’t supported state exchanges would face “incredible pressure” in those circumstances.
Less than one-quarter in the Kaiser poll thought that if the Court ruled against subsidies for the federal exchange, states shouldn’t act to create their own. Fifty-eight percent of Republicans, 70 percent of independents, and 82 percent of Democrats would want such an exchange.
Shifts in public opinion haven’t come quickly, but data show a rapid drop in the percentage of Americans without coverage, that premium costs are less than projected, that both the newly and still insured strongly like their policies, that fewer have medical debt and trouble paying medical bills, and that lives have been saved.
People who have to pay a penalty for no coverage in 2014 can avoid a penalty for 2015 if they get insurance by April 30.
When Rep. Cathy McMorris Rogers, R-Washington, asked for Obamacare horror stories, her constituents told her how much the law helped them and others.
One wrote, “I work for Cancer Care Northwest. We actually have more patients with insurance and fewer having to choose treatment over bankruptcy. Cathy, I’m a die-hard conservative and I’m asking you to stop just slamming Obamacare. Fix it, change it or come up with a better idea!”
As citizens like that change, politicians take notice.