It’s Politically Difficult to Eliminate Programs That People Like
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I’ve been arguing for years that the question is not how Obama, Pelosi, and Reid weren’t able to get more in the struggle to pass the ACA, but how they were able to pass the most important social welfare legislation in more than four decades given who the marginal votes were. McConnell and Ryan were not exactly in the same situation given the greater homogeneity of their conferences. But, still, I don’t think the question why they weren’t able to pass a repeal of the ACA but how they came so close:
Social programs are often not fully appreciated by their beneficiaries until someone proposes getting rid of them. Facing an existential threat made the Affordable Care Act much more popular – as then-Speaker of the House Nancy Pelosi predicted, support for it increased once people found out what was in it. The Republican proposals to replace the ACA, conversely, are staggeringly unpopular. As recently as last year, more Americans disapproved of the ACA than supported it, but its approval ratings are now over 50 percent, while the repeal bills started out unpopular and became more so.
The majority support for the ACA wasn’t soft, either. Supporters of the ACA were far more motivated than its opponents during the repeal struggle, putting their time and sometimes their bodies on the line, such as when disabled people were ejected from the offices of members of Congress. This helps to explain why moderate Republican Senators Susan Collins of Maine and Lisa Murkowski of Alaska (not to mention Democratic senators representing states that Trump won in landslides such as West Virginia and Montana) were unwavering in their opposition. The weekend after the HCFA was voted down, Murkowsi was repeatedly greeted by supporters, some in tears, thanking her for her no vote, while Nevada Senator Dean Heller was rewarded for his “yes” vote by seeing his approval rating plummet to 22 percent.
This doesn’t mean that supporters of the ACA should be complacent. Even when Republicans have failed to eliminate major social programs, they have been able to make them less generous in ways that caused real harm, Reagan’s Social Security adjustment included. Trump is signaling that he will damage the ACA administratively, and 19 states are still refusing the ACA’s generous Medicaid expansion.
Moreover, the failure to eliminate major welfare programs is a tendency, not an iron law. In 1996, President Bill Clinton signed a welfare “reform” bill that led to more than 6 million mothers with children losing welfare benefits.
That was possible partly because welfare, unlike Obamacare, only benefits the poor, who are politically disempowered.
Still, Republicans just came closer to passing a partial repeal of the ACA than many would have thought possible.
The battle over healthcare is far from over, but the repeated failures of the GOP efforts to repeal it prove the political durability of the social safety net.
The welfare state is very resilient, but not invulnerable. The ACA appears to have held, but it may well have been saved by 1,000 voters in New Hampshire. I wish the myth that Republicans secretly like the ACA was true, but it’s not, and McConnell retaining 49 votes for a bill that is less popular than cancer of the rectum underlines that. It’s a major win, but the war is still on.
So far, one thing has saved the Affordable Care Act from Republicans’ efforts to repeal it: When the votes counted, at least three Republican senators — along with every Democrat in the Senate — could not accept massive cuts to Medicaid.
Yes, Medicaid: a 50-year-old program targeting the poor and the near poor, a cornerstone of LBJ’s Great Society.
Wait, let me get this straight — the ACA wasn’t just one sentence, “Supreme Deity Gruber commands you to give all your moneys to insurance company CEOs kthxbi?” I have been misled for many years!