Washington, D.C’s current, unneeded crisis seems destined to lead to a federal government shutdown starting October 1. House Republicans have refused to fund the government unless the Affordable Care Act is defunded or delayed. Their strategy can’t succeed because the Senate will never agree and nor will President Obama.
Why are Democrats so opposed to a delay?
1. Increasing health care coverage is a long-term goal of the Democratic Party.
Democrats have long wanted to achieve greater health care coverage. While many point to President’s Truman embrace of health policy, it actually predates Truman. In research I conducted for my second book, Pathways to Polling, I saw internal White House documents from the administration of Franklin D. Roosevelt. Two years before the end of World War II, Roosevelt’s administration was planning for a post-war policy agenda that would include universal coverage.
And, of course, Democratic presidents Lyndon Johnson and Bill Clinton worked to try to cover Americans before President Obama. Johnson passed Medicare and Medicaid and, while Clinton didn’t succeed in broad health reform, he expanded poor children’s coverage.
2. Democrats believe the ACA improves the health care system and people’s health.
Today Democrats’ commitment to the Affordable Care Act is based on both their values and on evidence of what happened after coverage expanded. Massachusetts achieved 97% coverage after Gov. Romney adopted the Heritage Foundation’s model of individuals getting subsidies to help them buy insurance from a state-run insurance marketplace. This model, of course, constitutes a major pillar of the ACA. Research on earlier Medicaid expansion in the states also shows that lives were saved and health improved.
Now, numerous Democrats would like a more comprehensive system than the ACA. But they view the ACA as clearly better than what has existed before the ACA. They certainly don’t want to go back to insurance companies being able to deny coverage to people with pre-existing conditions and the health and financial harms inherent in that system.
3. Democrats want to demonstrate what really happens when the ACA is put into place.
This won’t happen right away, because it will take time and work to sign up the uninsured. The September 2013 Kaiser Health tracking poll found that only 15% of the public and 12% of the uninsured knew that the marketplaces would open on October 1, 2013.
Around 90% of people using the marketplaces will get financial aid, via subsidies, to help them buy insurance. But polls by Kaiser Health and the Pew Research Center found that around half of the uninsured know this is part of the Affordable Care Act. Pew found that people in states with state-run marketplaces are more likely to know about them.
There are some obstacles that will limit the success of the ACA. Some states won’t expand Medicaid, leaving millions uninsured. And some states have been so opposed to the marketplaces that they’ve tried to make it harder for navigators, whose job it is to help people sign up through the marketplaces. Still, millions will gain coverage and a recent analysis shows that the cost of premiums, even before subsidies, are lower than predicted.
[Addition to original post] Moreover, the ACA will undergo improvements over time. The day before the marketplaces are due to open, the federal government will be announcing multi-state insurance options which were negotiated with Blue Cross and Blue Shield. These increase options in Alaska, Arkansas, California, Colorado, Delaware, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Mexico, New York, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia and Wisconsin.
4. Democrats believe that when people experience the ACA, they’ll like it and it will be much more difficult to undo.
Democrats’ belief is buttressed by having opponents say so. In July 2013, Sen. Ted Cruz told Sean Hannity that it would be impossible to repeal the ACA after January 1, 2014 because “the exchanges kick in, the subsidies kick in.” In other words, people will want to keep the law in place.
Similar views motivated opponents of President Clinton’s health care plan. In 1993 strategist Bill Kristol wrote a famous memo counseling Republicans to try to defeat any health reform from Clinton, saying passing something would pose a “serious political threat to the Republican party.” Moreover, said Kristol said of passing health reform:
It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
Obviously, Democrats passing health reform could not help Democrats if Americans disliked it. Opponents and supporters think Americans will support the new policy regime once it’s in place.
5. Democrats believe those seeking to delay the ACA actually want to kill it.
This one is simple and rather obvious. Republicans repeatedly have said they want to “end Obamacare.” Mitt Romney said that if he won the presidency, he’d do it as soon as he could. House Republicans have tried to do so over forty times. So it’s clear that a delay is not being sought to improve the law but it overturn it.
6. Democrats believe implementing rather than delaying the ACA is politically better for them for the 2014 midterm elections.
If the ACA was delayed, opponents would be able to rail against it without opponents having to grapple with real people who were helped and real evidence about how it functions.
Imagine the 2014 ads with cancer patients who were able to get care because of the ACA or the young couple with a newborn baby in neonatal intensive care, a very expensive situation that would have bankrupted them. Those ads would be powerful and possible if the ACA goes forward without delay.
7. Democrats believe that the sooner Republicans come to terms with the fact that the ACA won’t be delayed or dismantled, the sooner they will work with them on improving the law and on other matters.
In 2012, Democrats won most votes nationally in House races, Senate contests and the presidency. Yet Republicans, who have a majority in the House, have tried to exert oversize influence over policy and have threatened both a government shutdown and a debt default. Democrats do not want to give Republicans any incentive whatsoever to continue these tactics. When the ACA goes forward, perhaps Tea Party Republicans will decide to leave behind their tactics of opposition and turn to the compromise that’s inherent in governing in a diverse, democratic nation.
For all these reasons, there is simply no way Democrats will agree to delaying the Affordable Care Act.