In the end, around seven million Americans signed up for Obamacare by the March 31 deadline, either through the federal exchange or through one of the fourteen exchanges set up by states (plus one in Washington, D.C.) that chose to run their own. That’s the target administration officials hoped for last fall, and considering the enrollment period’s hideous rollout, it came as quite a surprise to most commentators in Washington that it was reached. Republicans and conservatives spent months predicting that few would sign up, and that the law would simply perish of its own Rube Goldberg weight. But the “death spiral” of the Affordable Care Act, so anticipated on the Fox News Channel, failed to materialize.
There was quite a rush toward the end, particularly among younger, healthier enrollees, coaxed into participation by celebrities such as NBA star Kobe Bryant and the comic actor Zack Galifianakis, whose hilarious, deadpan interview with an obliging Obama on the comedy website Funny or Die went viral and led to a surge in visits to healthcare.gov. (“Where are you planning on building your presidential library, in Hawaii or your home country of Kenya?” Galifianakis asked the president.)
These younger people are said to account for 27 percent of all enrollees—not what the administration had hoped for, but enough, according to a Kaiser Family Foundation study from last December, to avoid the substantial hikes in insurance premiums that would result if there were not an adequate number of relatively healthy young people in the insurance pool.1
This is all good news for the administration, but what really matters is not how many people sign up for coverage, but how many actually end up paying for it over an extended period. Any household hit with an unanticipated expense—a major car repair, a sudden need to buy a child a new computer—might skip an insurance payment that month. Or a healthy person might sign up, not use the insurance for a year, and stop paying or cancel. These fluctuations, too, will have an impact on premium rates by 2015, when some fear we’ll be in for substantial rate hikes, even though a provision in the law requires insurers to provide extensive justification for increases greater than 10 percent.
The truth is that we won’t know for years the actual percentage of enrollees who are sick. The reason we won’t know, it’s worth recalling, is embedded in the law itself. Insurers can no longer ask applicants questions about their health or any preexisting conditions they may have. And precisely because the law’s authors knew this little catch-22 would arise, they built “shock absorbers,” or risk mitigation provisions, into the law, by which the government would share some of the risk of loss that insurance companies assume (and conversely would be rewarded a portion of excess profits).
In sum, while reaching the enrollment target was a good start, much about the law’s impact is up in the air and will remain so for some time. But the self-anointed political experts who fancy themselves to be Washington’s arbiters of the conventional wisdom need judgments and need them now. Among that group, the verdict was long ago rendered. The law is a disaster for Democrats. This has been the view for months, indeed years, and it congealed fully in early March after the special congressional election in a Florida swing district near Tampa Bay, where the Republican, David Jolly, defeated Democrat Alex Sink by less than 2 percent (a libertarian third candidate took nearly 5 percent).
Inevitably, this narrow win in a low-turnout race was declared “a referendum on Obamacare.” But if you looked closely, some data suggested that the health care issue actually helped Sink marginally and made the result a little closer than it might have been. Geoff Garin, Sink’s pollster, told me afterward that Jolly’s “repeal Obamacare” position was more unpopular than Sink’s “keep it and fix it” position. Sink’s support improved when respondents were reminded of the specific consequences of repeal—i.e., that insurers could use preexisting health status to refuse to issue a policy, reimpose lifetime caps, charge women more than men, and so on.
It has been said for months now that Obamacare will be the most important factor in this fall’s elections. Certainly, Republicans have vowed to make it so (the House took its fifty-second vote to repeal the law in March). Far from forcing Republicans to reconsider their approach, the meeting of the enrollment target merely led them to dismiss the numbers as phony.
They do so in part because when it comes to Senate elections they are benefiting from a very promising map. Democrats must defend incumbencies in Louisiana, North Carolina, Alaska, and Arkansas, while trying to compete in three other red states, West Virginia, Montana, and South Dakota, where incumbent Democrats are retiring. In all seven of those states, Obamacare’s approval ratings, not to mention those of Obama himself, are well below the national average. So it probably makes a certain sense for the GOP, and outside groups funded by the Koch brothers and others, to inveigh against big-government socialism as much as possible.
But the odd thing about Obamacare is this: while people dislike the word and the abstract idea of it, they favor most of its particular provisions in large numbers. This seeming contradiction is, of course, an old reality in American politics. We might recall that Bill Clinton was fond of saying that the American people are “rhetorically conservative and operationally progressive.” Clinton was leaning on the research of Lloyd Free and Hadley Cantrill, the political scientists who identified this tendency back in 1967. Most people are seduced by conservative rhetoric—about cutting back spending, taxes, and government generally, say—but when they’re presented with a list of programs and asked which ones they’d cut, it turns out they kind of like many liberal programs.
And so it is with the Affordable Care Act. The name itself has become symbolic of the interfering state, so it polls poorly. But when people are asked about its specific provisions, numbers tend to resemble those from a Kaiser poll in mid-March: approval of extension of dependent coverage, 80 percent; of closing the Medicare prescription drug “doughnut hole,” 79 percent; of providing subsidy assistance to help people purchase coverage, 77 percent; of Medicaid expansion, 74 percent; of guaranteed issue, 70 percent. The only major plank that polled below 50 percent in the Kaiser survey was the individual mandate, at 35 percent. The mandate, along with people’s general suspicions that Obamacare is going to increase rates, is the act’s true Achilles heel.
Still, the rest of the provisions should help Democrats, if they’re not afraid to use them. To a Republican candidate thundering about repeal it can easily be said: “So, you want insurers to be able to deny sick people coverage? You want to allow them to throw people off their rolls if their care costs too much?” Another potentially useful rejoinder centers on the expansion of Medicaid. States refusing to accept federal money to operate their own exchanges for the poorer people who qualify for Medicaid are saying good-bye to billions. According to a December 2013 study by the Commonwealth Fund, Texas is sacrificing $9.6 billion; North Carolina, $2.6 billion; Florida, $5 billion; Georgia, $4.9 billion. That’s depriving citizens of a lot of money.
And so, as The Washington Post’s Greg Sargent has reported, it has come to pass in Michigan that the Republican candidate for the open Senate seat created by Democrat Carl Levin’s retirement, Terry Lynn Land, has taken the comical position of wanting to repeal Obamacare while simultaneously endorsing the Medicaid expansion, which is worth $2.6 billion to the state and which the conservative Republican governor is pursuing.2
Republicans have other vulnerabilities when it comes to Obamacare. And they know it, too. This is why three GOP senators—Orrin Hatch of Utah, Richard Burr of North Carolina, and Tom Coburn of Oklahoma—introduced a health care bill in late January. When Democrats pose to Republicans the questions I’ve raised, campaigning Republicans need to say that they’re for something. The bill is an amusing piece of work, coming from Republicans: it retains some of the main features of the same Obamacare law they despise, like barring insurers from imposing lifetime caps on insurance payments; and it imposes what is in essence a tax increase (yes, from Republicans) on people who hold pricey employer-provided coverage by limiting the tax exemptions that individuals are allowed to take for those plans. When they get around to trying to make actual policy, some Republicans see that money is required.
But in fact they’re only trying to make something that looks like actual policy. In the summer of 2010, Republicans, who to that point had been only for repeal of Obamacare, started talking about “repeal and replace.” Then in November they won control of the House, and they promptly dropped the “replace” part. Now that it’s time for another midterm election, they (or some of them) are mentioning “replace” again. They have to seem like they’re offering an alternative. But they also have to keep it vague—apart from Hatch, Burr, and Coburn, few other Republicans can actually endorse their bill, you see, because of the tax increase.
With the enrollment success, Obamacare may well be turning a corner. If Democratic candidates can make the conversation about the act as specific as possible, most of them should be able to fight the issue to a draw. In some states with contested Senate races, Michigan and perhaps Colorado for example, they might even gain an advantage from it.
Still, the Democrats cannot feel relieved about November. It’s likely to be quite bad for them. Senators up for reelection this fall were elected (or reelected) in 2008—a big Democratic year. The party won eight Senate seats in that election, an unusual amount in this day and age. So now, in a nonpresidential year, the bill is coming due. The bright side for Democrats is that 2016 augurs very favorably indeed, because 2010, the year of the Tea Party, was a year in which a number of Republicans won seats that are normally Democratic. If Republicans capture the Senate in 2014, most of the experts on elections appear to think the Democrats may well win it back in 2016.
For this year, Republicans have a strong advantage, and in many cases, they don’t even need to say “Obamacare.” Simply saying “Obama” should work well enough.
Obama’s unpopularity—since last fall, polls have typically found his disapproval number to be six or seven points higher than the approval figure—has a few different sources. Certainly the slow economic recovery, with persistent high unemployment, is the main reason. In a mid-March NBC/Wall Street Journal poll, a staggering 57 percent of respondents said they believed the country was still in a recession (whereas economists say the recession ended five years ago). There was also the screwed-up launch of Obamacare itself; the many millions spent inaccurately attacking the new law; the lack of any dramatic result in foreign policy; and the determination of congressional Republicans to oppose nearly every Obama initiative, resulting in a dysfunction that inevitably leads many average citizens to pin some blame on the president.
In Alaska, Democrat Mark Begich is still given a decent shot at winning reelection. But Obama’s approval rating there was 33.5 percent as measured by Gallup over the course of 2013 (the national average was 46.5 percent). In Arkansas, where the experts give Democrat Mark Pryor very little chance of hanging on, the president had a 34.9 percent approval rating. In Louisiana, where Mary Landrieu is likely to be challenged by a GOP House member, Obama stood at 40 percent.
In North Carolina, Kay Hagan might have a slightly better chance at winning, and it’s in part because Obama has been less unpopular there—43 percent, according to Gallup. But elsewhere, in the three open seats that the Republicans seem likely to pick up, Obama’s ratings are among his lowest—33.1 percent in Montana, 31.7 percent in South Dakota, 25.1 percent in West Virginia.
Those are the six seats Republicans really have their eyes on. Winning all of them is plausible. On days when Republican operatives are feeling expansive, you’ll see them mention also Colorado, Iowa, and Michigan as possibilities, but those three are not as favorable to Republicans as the other six.
Two closely contested states where the Democrat could beat the Republican are made all the more interesting because both are in the South, and in both cases the Democrat is a woman. In Georgia, Michelle Nunn, daughter of Sam Nunn, will face a challenger to be decided in a May 20 primary (the Republican incumbent is retiring). Georgia is known as a right-wing state, but the three leading GOP contenders might put that proposition to the test. One, Paul Broun (pronounced “Brown”), has said that the theories of evolution and the Big Bang both come “straight from the pit of hell.”
The more tantalizing thought for Democrats is the prospect of beating Mitch McConnell in Kentucky. Some Democrats get along personally with members of the other party, but more than a few Democrats seem to loathe McConnell. The Democrat who will face him is Alison Lundergan Grimes, the thirty-five-year-old secretary of state. She appears to be running a highly competent campaign. She leads McConnell in most polls, if only by a couple of points. Of course, McConnell has not spent millions of dollars attacking her yet, so she’ll need to hold up to the kind of rough-housing that’s to be expected. But Kentucky is not a Republican state in the way some old Confederate states are—for example, every statewide officeholder (at the state level, not federal) is a Democrat. Governor Steve Beshear embraced Obamacare, and it seems widely accepted in his state.
If Lundergan Grimes or Nunn can win, and if at least one of the troika of Begich, Hagan, and Landrieu can hold on, the Democrats will retain control. A Republican majority would require a serious tidal wave. This could happen if key Democratic groups—young people, single women, and Latinos in particular—don’t vote.
Turnout is fate in midterm elections. Democrats have long suffered from this reality. Back in 1994, for example, the year the Republicans won fifty-four House seats after running on Newt Gingrich’s “Contract with America,” turnout was 39 percent, substantially down from 1992’s 55 percent. The falloff occurred mostly within groups that leaned Democratic—lower-income households, for example.
Today, with our increased polarization and a political discourse more and more defined by cultural cleavages, those groups whose participation drops off are more strongly Democratic than they were twenty years ago, while the groups whose voting rate stays high—elderly white voters, notably—are more Republican than they were. This means that the decline that was bad for Democrats two decades ago could be catastrophic for them now.
Democratic strategists understand this and say they’re committing unprecedented resources to getting their vote out. They’ve given this project a name, the Bannock Street Project, which was the street in Denver where Senator Michael Bennet’s turnout operation was based in 2010. Bennet successfully held a Tea Party opponent at bay that year, partly because Colorado was one of two states (Harry Reid’s Nevada was the other) where the Democrats invested in getting out the vote.
They will now try to do in ten states what they did that year in two. The goal is to spend $60 million on field operations alone in those states, with four thousand paid staff out knocking on doors. If that materializes, it ought to be enough to hold off at least a couple of Republicans.
The Supreme Court’s April 2 McCutcheon v. FEC decision might well complicate these calculations. Now—starting this fall—wealthy donors can spend nearly limitless aggregate amounts on federal elections. Until the decision, a single wealthy donor could not spend more than a total of $123,200 during a particular election season. Now that donor can pump $6 million into a single congressional election, backing as many other candidates as he or she pleases by means of contributions to the political parties and to PACs that will steer the money to candidates.
This change may not alter the habits of such billionaires as Sheldon Adelson, the Las Vegas magnate who poured, via Super PACs and other means, at least $100 million into the 2012 elections, according to Trevor Potter, a lawyer and former federal election commissioner who supports reform (not as John Roberts defines it). Potter says that it’s “the top two-hundred members of the donor class” who will be the key beneficiaries here. And aren’t they more Republican than Democratic? “Yes, that’s probably true,” Potter says.
Whatever the effects of the decision, the problem Democrats will face is one of motivation. Conservative base voters will be eager for victory—the mere fact that Barack Obama remains president is effrontery enough as far as they’re concerned. With a serious prospect of turning the Senate red, these voters will almost certainly show up in considerable numbers. It’s hard to say, in contrast, what will galvanize Democratic groups. It’s not impossible to think now that rank-and-file Democrats could be feeling much greater pride of ownership of the Affordable Care Act by November and will go to the polls in its defense. But generally speaking, fear and loathing are much greater motivators.
As it happens, the Republicans may have handed Democrats just such ammunition in the form of Paul Ryan’s new budget, which he released the day after the Obamacare numbers came in. The budget would rip $5.1 trillion over ten years out of the domestic budget while increasing defense spending, and it would alter Medicare for those now under fifty-five, getting the camel’s nose of privatization under the tent, as it were. As I write, House Republican leadership was planning on forcing a vote on the budget, which would put them all on record in support of attacking (as the Democrats will surely put it) Medicare in an election year.
At some point, Democrats would be well advised to focus their voters’ minds on what a Republican Senate majority would mean. The Senate could join the House in its fishing-expedition investigations into the IRS “scandal” and Benghazi (with Hillary Clinton leading every Republican presidential hopeful by double digits, the desire to visit any discomfort they can upon her will be strong). Remember also that under Democratic control, the Senate has simply refused to take up many bills passed by the House. In GOP hands, the Senate will bring all those votes to the floor—draconian budgets that might pressure Obama into accepting deep cuts, and votes to repeal Obamacare (Obama will veto those, so the law won’t be threatened in any real way).
There is also the question of nominations. If there’s a Supreme Court vacancy, it seems possible to many observers that Republicans simply wouldn’t permit any nominee named by Obama to get a hearing. Nominations to lower courts and executive branch positions will meet a similar fate. Then there’s the prospect of the pretended threat of impeachment, a ploy to distract the president and strip him of authority. Obama’s final two years as president would almost surely be a tougher grind than the previous six. Perhaps far tougher, difficult as that might be to imagine.
A somewhat mitigating factor: in five remaining states, Tea Party rightists are challenging establishment conservatives in the primaries. I say “remaining” because the challenge of that sort in Texas, against John Cornyn, ended with Cornyn’s easy win over the Tea Party’s Steve Stockman on March 4. The other five primaries will take place between May 20 and August 7, and the most notable incumbents being challenged from the right are McConnell and Lindsey Graham.
For the most part, these results aren’t likely to affect the partisan balance of the Senate. These primaries are all happening in states (except Kentucky) where the odds of a Democrat winning a Senate election are slim indeed.
But by the morning of August 8, we’ll have a sense of how much life is left in the Tea Party movement, and whether it can continue to strike fear into more mainstream conservatives. The Republican Party swears that it is fighting the extremism within its ranks. McConnell even said in early March that “we are going to crush them everywhere.” And he might be right about that—generally, these five incumbents will have too much money and will have dispensed so many favors to so many constituents over so many years that they can survive challenges from outsiders. The polls so far show a close race only in Mississippi.
What would be the consequences for our politics if the Republican establishment candidates were to prevail in this summer’s primaries? We may see some softening of opposition to Obama on the margins. If you are a Republican, the main thing you’re not supposed to do, from the Tea Party point of view, is negotiate or compromise in any way with the Obama administration. That would be capitulation to an enemy. Tennessee’s Lamar Alexander, for example, one of those being challenged, has supported most of Obama’s judicial nominations. And then he made the error of backing the administration’s new clean-air rules. This prompted a letter from Tea Party groups from around the state that included this sentence: “Unfortunately, our great nation can no longer afford compromise and bipartisanship, two traits for which you have become famous.” If Alexander and the others survive, there’s a decent chance that the Senate’s old-line conservatives will be a little less afraid of the Tea Party and a little more willing to make deals or occasionally cross the aisle.
The intraparty fight will then be transferred to the presidential race. Inside the Beltway these days, Kentucky Senator Rand Paul has been anointed the front-runner now that Chris Christie’s image as a transpartisan truth dispenser has suffered evidently irreparable damage. (At least for now; in politics, who really knows?) Paul is a Tea Partier who has moved into the top tier in recent polls of Republicans asked to name their preferred GOP candidate. But he typically trails Hillary Clinton by ten points or more. He is bound to make the leaders of the party establishment nervous, and they’ll try to find a candidate to beat him.
But the Republican establishment might not call the shots the way it has for decades. With Christie no longer the establishment front-runner, the contest for the White House doesn’t really have one right now. And most of the likely candidates—Rand Paul, Ted Cruz, Marco Rubio, Wisconsin Governor Scott Walker—are quite far to the right. So any obituaries of the Tea Party this August might end up being premature.
See Larry Levitt, Gary Claxton, and Anthony Damico, “The Numbers Behind ‘Young Invincibles’ and the Affordable Care Act,” Kaiser Family Foundation, December 17, 2013. ↩
See Greg Sargent, “Bleeding Heart Republicans Really Want Health Reform. No, Really,” The Washington Post, February 28, 2014. ↩