Before President Trump took office, only 43% of voters approved of the law. That’s up to 50% now.
A Kaiser Family Foundation poll released in December 2016, just before President Obama left office, showed that the Affordable Care Act had a favorability rating of 43%, while 46% viewed it unfavorably. Last month, the same poll showed the nine-year-old health-insurance law well above water, with 50% viewing it positively to 39% negatively.
Those numbers help explain why most Republicans in Congress aren’t eager to campaign on repealing ObamaCare in 2020. Republican candidates ran hard on “repeal and replace” in 2016, and voters rewarded them with the presidency and GOP majorities in both chambers of Congress. The party’s infighting and epic failure to deliver on that campaign promise is one reason Nancy Pelosi is once again speaker of the House.
Some aspects of ObamaCare—protection for people with pre-existing medical conditions, coverage for young adults through their parents’ insurance plans—enjoy bipartisan support among voters, and many Republican lawmakers are content to focus for the time being on tweaking the law rather than repealing it. Alas, President Trump has other ideas. Republicans today are no closer to agreeing on an ObamaCare alternative than they were when Mr. Trump was elected, yet he wants to dust off the “repeal and replace” slogan for 2020.
Last month the Justice Department reversed itself and opted to support a federal District Court ruling that the Affordable Care Act is unconstitutional. In December, Judge Reed O’Connor ruled that since ObamaCare’s individual mandate violates the Constitution, so does the rest of the law. Previously, Justice argued that only certain provisions of the law should be invalidated. Now it agrees with Judge O’Connor that the whole thing should go. The case is currently before the Fifth Circuit Court of Appeals, but chances of success are slim. Chief Justice John Roberts, who provided the fifth vote in the Supreme Court decision upholding the individual mandate in 2012, is not likely to change his mind. But even if he did, the Supreme Court has a long history of voiding certain provisions of a law without declaring the entire statute unconstitutional.
Even if Republicans prevailed in court, the victory would almost certainly be pyrrhic. After House Republicans voted in 2017 to grant states conditional waivers to avoid certain ObamaCare mandates, Democrats accused them of opposing insurance coverage for people with pre-existing conditions. It wasn’t true but it was easy to demagogue, which is exactly what Democrats did. In the midterm elections the following year, Republicans got pummeled by swing voters who didn’t trust them on health care. Imagine the backlash that would follow a Republican-backed court decision that stripped people of their health coverage and forced states to roll back Medicaid expansion with no viable alternative in place—all right before a presidential election.
Repealing ObamaCare is impossible so long as Democrats control the House and it’s impractical so long as Republicans can’t get their act together on a replacement. Democrats would like nothing better than to run next year as guardians of health insurance while painting Republicans as keen to take it away. The mystery is why Mr. Trump sounds so eager to oblige his political opponents in a manner that complicates not only his own re-election but that of other Republicans on the ballot.
If the president wants Republicans to run on health care next year, why not put forward some pragmatic ways to lower premiums and deductibles for low-income patients? Why not talk up the merits of more health savings plans, or of expanding the use of health reimbursement accounts to cover out-of-pocket medical expenses? Just 5% of patients account for around half of the nation’s health-care spending, and the president might explain how a federal reinsurance fund could help states finance their care. None of this will stop Democrats from lying to voters about Republicans and health insurance, but it will enable GOP candidates to go on offense when the topic turns to ObamaCare.
Mr. Trump could also put his Twitter account to use explaining the pitfalls of Medicare for All proposals that Kamala Harris, Bernie Sanders, Elizabeth Warren and other leading Democratic presidential candidates have been hyping. When voters learn that these schemes involve tax increases and the elimination of private health insurance, support tanks. The White House should make sure more people know the details.
As things stand now, Republicans will have plenty to brag about when making their case to voters next year: Strong economic growth and job creation, less regulation, conservative judges and vindication in the Robert Mueller investigation. If Mr. Trump wants to add health care to the mix, fine, so long as he’s mindful that Republicans have made a mess of the issue thus far and that voters don’t have an infinite amount of patience.
This piece originally appeared at The Wall Street Journal
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