Obamacare Opponents Haven't Surrendered. They Were Defeated

(Photo via the White House Flickr feed)

On Wednesday, the Republican House of Representatives passed a bill to fund the government that did not include language defunding Obamacare (although the bill would delay the implementation of the law’s health insurance exchanges). Following the recent decisions of some Republican governors, including conservatives such as John Kasich of Ohio and Rick Scott of Florida, to move forward with the law’s expansion of Medicaid, this development is a blow to Obamacare’s most strident critics.

That isn’t to say that all Republicans are resigned to Obamacare. Senators Ted Cruz of Texas and Mike Lee have announced that they’ll try to attach measures to delay Obamacare funding to the House-passed Continuing Resolution in the Senate. House Republicans plan to include a full repeal of Obamacare in their budget to be released next week. And conservative activists are as incensed as ever.

Clearly, the opposition to Obamacare hasn’t surrendered. But it has been defeated, even if some haven’t yet come to terms with their loss. President Obama sealed the law’s victory with his reelection.

That doesn’t mean that the American health care landscape is now settled. Far from it. But it does mean that the Affordable Care Act will be a key feature of its topography.

Some conservative policy leaders have tried to spell out a path for conservative health care policy with Obamacare in place. Perhaps most notably, Douglas Holtz-Eakin of the American Action Forum and Avik Roy of the Manhattan Institute took to Reuters’ pages to suggest ways in which Republicans could alter Obamacare to move the system in a conservative direction by increasing consumer choice and lower federal spending.  

The two argue that the very basic structure of Obamacare – especially the creation of the health insurance exchanges – is amenable to deregulation and consumer-choice reforms. Although their piece wasn’t received with an outpouring of approval from other conservative policy leaders, in time such attempts to reconcile Republican health care policy with political reality will gain currency.

What’s not as clear is how the politics of health care will shake out for the Republican Party.

The GOP has relied heavily on Obamacare repeal as a motivating tool for its base over the past two-plus years. Opposition to the bill helped spark the Tea Party. In the spring of 2010, Republicans thought that the struggling economy and mounting debt would be their strongest campaign issues. But GOP leadership quickly realized that Obamacare had greater potential energize the Republican base.

Eventually the GOP struck out in stopping Obamacare. The first strike was when the bill was in consideration in Congress. When Scott Brown won a special election in Massachusetts to replace the recently departed Ted Kennedy, it appeared that the bill might be stopped, although ultimately Democrats found an alternative legislative path forward. Strike two was the Supreme Court’s decision to uphold the law even while declaring the measure’s individual mandate unconstitutional as originally written. The punchout came with Mitt Romney’s defeat in the general election.

Romney himself, though, may not have had a particularly keen sense of the stakes regarding the health care law. In an appearance on Fox News Sunday, Romney suggested that the law helped Obama by drawing the support of uninsured voters. Conservatives have interpreted Romney’s words as a sign that he didn’t understand the politics or the urgency of the issue.

Three strikes are all you get. There may be just as much conservative outrage and public disapproval of Obamacare as there was in November, but it can no longer be directed toward any realistic goal, barring an unprecedented realignment of American politics in the next two years. The only question remaining is how conservatives can delay various provisions of the law. Already, most lawmakers have adjusted to this reality: Politico reports that even conservative lawmakers have shifted their strategy away from repeal and toward attacking smaller, more controversial parts of the law, such as the medical device tax and IPAB, the board of experts tasked with reducing Medicare spending.

Obviously the stakes involved in such efforts are much lower. Not in policy terms – health care costs are still the main driver of the public debt and the cause of distress to household budgets. It will be, and should be, a preeminent public policy issue for the foreseeable future. And Republicans will continue to capitalize on the law’s unpopularity as its key provisions come online and the inevitable glitches and failures manifest themselves. But whether the right likes it or not, the law is here to stay.  


Joseph Lawler is editor of RealClearPolicy. He can be reached by email or on twitter.

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