The San Juan Daily Star
Obamacare keeps winning
By David Leonhardt
The government benefits began their existence as objects of partisan rancor and harsh criticism. Eventually, though, they became so popular that politicians of both parties promised to protect them.
It was true of Social Security and Medicare. And now the pattern seems to be repeating itself with Obamacare.
Consider what has happened recently in North Carolina: Only a decade after the state’s Republican politicians described the law as dangerous and refused to sign up for its expansion of Medicaid, Republicans and Democrats came together to pass such an expansion. The Republican-controlled House in North Carolina passed the bill 87-24, while the Republican-controlled Senate passed it 44-2.
“Wow, have things changed,” Jonathan Cohn wrote in a HuffPost piece explaining how the turnabout happened.
Obamacare — the country’s largest expansion of health insurance since Medicare and Medicaid in 1965 — is still not as widely accepted as those programs. North Carolina became the 40th state to agree to expand Medicaid under Obamacare, which means that 10 states still have not, including two of the largest, Texas and Florida. In those states, more than 3.5 million adults lack health insurance as a result.
But the list of states signing up for the program seems to be moving in only one direction: It keeps growing.
In its growing acceptance, Obamacare resembles other major parts of the federal safety net:
— When Congress was considering Social Security in 1935, conservatives and many business executives bitterly criticized it. One Texas newspaper described Social Security as “a huge sales tax on everybody on behalf of the oldsters.” A Wall Street Journal editorial predicted that the law would eventually be reason for Congress to look back in “humiliation.” Not exactly: Social Security is so popular that it is known as a third rail in American politics.
— When Congress was debating Medicare in the 1960s, Ronald Reagan — then an actor with a rising political profile — attacked the program as a step toward socialism. If it passed, Reagan warned, “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.” As president, Reagan praised and supported the program.
— After Congress created Medicaid — a health-insurance program primarily for low-income households — in 1965, some states did not initially join it. Arizona became the last to do so, in 1982.
Roberts and McCain
In the initial years after Obamacare’s passage in 2010, it was similarly divisive. Blue states embraced it, while many red states rejected its voluntary Medicaid expansion. In Washington, congressional Republicans and Donald Trump tried to repeal it. Some Republican-appointed judges invalidated parts of it, and every Republican appointee on the Supreme Court except Chief Justice John Roberts voted to scrap the law.
Twice, it survived by a single vote — first, by Roberts’ 2012 Supreme Court vote, and then by Sen. John McCain’s late-night vote against its repeal in 2017. Since then, however, Obamacare has been gaining Republican support.
The next year, voters in Idaho, Nebraska and Utah — red states, all — passed ballot initiatives expanding Medicaid. Oklahoma, Missouri and South Dakota have since done so. Montana’s state legislature has also approved an expansion.
In 2019, Gov. Andy Beshear of Kentucky, a Democrat, narrowly won election in a Republican state by pledging to protect an earlier Medicaid expansion. In North Carolina, Roy Cooper, also a Democrat, became governor in a 2016 upset partly by campaigning in favor of an expansion — and was able to sign one this week.
(Before it takes effect, Cooper and the legislature must agree on a state budget.)
These developments are a sign of the law’s growing popularity. And that popularity isn’t especially mysterious: In a country with high levels of economic inequality and large numbers of people without health insurance, Obamacare has increased taxes on the affluent to subsidize health care for poor and middle-class families. At root, it is an effort to reduce inequality.
Winning the middle
Even with its flaws — including its often complicated process for signing up for insurance — the law has achieved many of its aims. The number of Americans without health insurance has plummeted. In states that have refused the Medicaid expansion, by contrast, rural hospitals are struggling even more than elsewhere because they do not receive the law’s subsidies for care.
Greenwood Leflore Hospital — in the Mississippi Delta — is an example. It recently closed its intensive-care unit and maternity ward, as The New York Times’ Sharon LaFraniere has reported. Nationwide, states that did not quickly accept Medicaid expansion have accounted for almost three-quarters of rural hospital closures between 2010 and 2021, according to the American Hospital Association.
Similar problems in North Carolina were a reason that Republicans there reconsidered their opposition to Medicaid expansion. “We had these people coming down to Raleigh, farmers, business owners, people from rural areas, they were advocating, telling stories,” one Republican state representative told HuffPost.
Many Republicans still oppose Obamacare, and some hard-right members of Congress also favor cuts to Medicaid — as well as to Medicare and Social Security. In a country as polarized as the United States, there isn’t much true political consensus. But Obamacare has won over the political middle more quickly than seemed likely not so long ago.