WASHINGTON (Circa) — After years of running away from the Affordable Care Act, Democrats are embracing the health care law that once cost them their majorities in the House and Senate.
With three months until the November elections, numerous polls show health care at the top of the list of issues Americans care most about, in some cases surpassing jobs and the economy. At the same time, the public's approval of President Barack Obama's signature policy achievement has steadily increased over the past year following the failed attempts by President Donald Trump and Republicans to repeal the law, with more Americans supporting than opposing the health care policy.
Increasingly since June, Democrats have shifted their campaign message to focus on protecting Obamacare. Republicans, who made repealing and replacing Obamacare their top priority in elections from 2010 through 2016, have quietly moved on to other issues.
"Another way of looking at it is Republicans blew it," said Steven Smith, the director of the Weidenbaum Center on the Economy, Government, and Public Policy at Washington University. "Not only did they fail to repeal Obamacare, but they actually created an issue that Democrats can now run on more effectively... It actually enhanced its popularity."
According to the Kaiser Family Foundation (KFF), Republican threats to the health care system turned public support in favor of the law. The Affordable Care Act's popularity spiked during and after the Republican-controlled White House and Congress months-long effort to repeal and replace it.
Though the issue of health care was more likely to mobilize Democrats than Republicans or independent voters, almost one-third of women voters (29 percent) polled by KFF said health care was the most important issue candidates can discuss in the upcoming midterm election. Men cited health care as the second most important issue after jobs and the economy.
The repeal and replace effort also revealed the underlying popularity of certain features of the Affordable Care Act, especially guaranteed coverage for pre-existing medical conditions, extended coverage for children up to 26 years old under their parents' insurance and guaranteed minimum benefits. Among likely voters, roughly two-thirds said that a candidate's position on protecting coverage for pre-existing conditions would be the single most important factor or very important in determining their vote in November.
Having found an issue that resonates with their base, Democrats are playing aggressive defense for Obamacare, accusing their political opponents of taking away access to medical care.
"One wouldn't have thought health care would have been that kind of issue five years ago, but the Republicans made it that," Smith explained, pointing to overwhelming Democratic support for Obamacare's core protections, like pre-existing conditions. "The Democrats were just handed this issue and it's fairly easy for them to run on it."
Despite Republicans coming up one Senate vote short of repealing the ACA last year, the GOP-controlled Congress and White House have succeeded in rolling back some of the most unpopular elements of the law. Republicans can claim credit for repealing the individual mandate through the 2017 tax cut bill. The Trump administration also finalized a rule on Wednesday to allow insurers to sell inexpensive, short-term health insurance plans outside the Obamacare minimum benefit requirements.
"When you look at what the Republicans have actually done, it's a good record. Republicans just have to be brave enough to campaign on it," said Peter Ferrara, a senior policy analyst at the conservative Heartland Institute.
Earlier this week, Democrats wasted no time in attacking President Trump's plan for short-term health coverage. Senate Minority Leader Chuck Schumer denounced the plans are "junk insurance" claiming the low-cost, low-coverage plans "will essentially repeal protections on pre-existing conditions."
On Thursday, Schumer told reporters that Democrats intended to force a vote to block the introduction of the low-cost insurance plans. Though it is unlikely to pass the Republican-controlled Senate, it underscores Democratic confidence in health care as a winning issue for them in the midterms.
Most of the short-term plans are not expected to cover pre-existing conditions, but their introduction into the health insurance marketplace will not repeal existing protections.
David Kendall, a senior fellow for health policy at the left-leaning Third Way Fellow for Health and Fiscal Policy, said it is understandable why many Republicans are running away from the Obamacare issue in 2018.
Even their successful repeal of the unpopular individual mandate may not be enough to impress voters this fall, he said, noting it did nothing to solve the problem of rising insurance costs.
"What voters are looking for is for someone to do something about the problem. And that's where Republicans are very vulnerable right now because they just haven't done it," Kendall said.
In the process of trying to reform the existing health care system, Republicans effectively inherited responsibility for a program that, according to the president, is in a "death spiral" of increasing costs to consumers and the government.
Government subsidies to the Affordable Care Act increased in recent years by nearly $10 billion, according to analysis by the Center for Health and Economy. The government paid $32.8 billion in 2016 and approximately $42.6 billion in 2017 to offset the rising cost of premiums and keep prices stable for those receiving the ACA tax credit.
For those who do not qualify, premiums for individual insurance plans have more than doubled between 2013 and early 2017, according to multiple reports. Family premiums increased by roughly 140 percent by early 2017, according to analysis by eHealth.
Those costs are expected to rise again in most states, as insurers finalize their 2019 rates in response to the repeal of the individual mandate and other changes to the health care law. Consumers could again see double-digit increases, said eHealth CEO Scott Flanders, suggesting, "This is a continuation of a trend, not a new development."
By making the issue of health care core to the 2018 midterms, Democrats have arguably shown a commitment to enact basic stabilization measures to address the mounting costs under the current system, Kendall said. Though it is unclear whether President Trump will work with Democrats to stabilize Obamacare, the presidential election in 2020 will further define the direction for health care policy.
Going into 2018 and 2020, a growing number of Democrats are campaigning on a government-funded, single-payer health care system. More than a dozen Democrats in the Senate signed onto a bill this year promoting "Medicare for All" and 70 House Democrats banded together last month to form a Medicare for All Caucus. Recent estimates suggest a fully government-run health care system could cost taxpayers more than $32 trillion over ten years.
Recent polls suggest a growing majority of Americans are open to the idea of government-run health care, but pushing the idea too hard could fracture the Democrats' message, Smith warned.
"There's no consensus among the Democratic Party conferences about moving in that direction," he said, though some liberal states are moving towards Medicare for all or a statewide public option.
Those differences among Democrats over universal health care may not catch up with the party until 2020, Smith added. Midterms tend to be a referendum on the incumbent party, not the strength of the opposing party's platform.