Even a GOP president might not kill Obamacare: Jill Lawrence

Republicans in Congress finally achieved their long cherished goal of sending President Obama a bill to repeal his signature health care law. It was a brief victory that lasted only until he vetoed it
two days later. But it could be the high-water mark of the repeal drive that has been a pillar of conservative campaigns since 2010 — even if Republicans win the White House.

The politics of the Affordable Care Act are changing, as even the newly elected Tea Party governor of Kentucky has acknowledged. Polling on the ACA, or Obamacare, reveals as much public division and ambivalence as ever toward the complicated health law. But it is beginning to reach a critical mass of users and people who know them — and that is the key to survival.

Political success often hinges on how many Americans personally know people affected by an issue. For instance, 42% in a 1992 CBS News poll said they knew someone who was gay or lesbian. By 2010, 77% said they knew someone (it was 84% among those under 30). Congress voted that year to repeal the “don’t ask, don’t tell” policy that banned openly gay people from serving in the military. Last year, the Supreme Court legalized same-sex marriage. The political developments directly corresponded with rising acceptance of gay relations and same-sex marriage.

Another example is immigration. Repeated polls have shown that legal and undocumented immigrants are not separate groups with different politics. About a quarter of registered Latino voters in a 2014 poll said they personally knew someone who had been detained or deported in the previous 12 months. More broadly, nearly two-thirds of Latino voters say they personally knew someone who is undocumented — a statistic that explains why GOP presidential candidates hostile to undocumented immigrants struggle for support from legal immigrants. Despite recent legislative setbacks, given the political importance of Latino voters and their interwoven communities of the documented and undocumented, ultimately some form of legalization or a path to citizenship seems inevitable.

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There are about 9 million gay adults and 11 million undocumented immigrants in the United States. Obamacare users are far more numerous than either group. For comparison purposes, Health and Human Services Secretary Sylvia Burwell said in September that 17.6 million people were insured through the health law, and she predicted an additional 10 million could sign up during the three-month enrollment period that ends Jan. 31.

Who are those insured?

• People under 26. They may be in school, starting a business, job hunting or working for employers who don’t offer health insurance. A 2013 Commonwealth Fund report found that 7.8 million young people on their parents’ plans would not have been eligible to do so before the 2010 law.
• People with pre-existing conditions. Insurance companies routinely denied them individual coverage or charged exorbitant rates until Obamacare stopped those practices. HHS estimates that up to 25 million people with pre-existing conditions did not have group insurance through an employer and would need individual plans. This guaranteed coverage is no small thing, especially for older Americans struggling to find work but too young for Medicare.
• People eligible for Medicaid, the federal insurance program for poor and low-income people, due to a federally funded expansion in the health care law. Thirty states have adopted it in some form, and four more are considering it. HHS says more than 12 million people below or slightly above the federal poverty level have coverage due to the expansion.

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Obviously, not everyone likes or wants Obamacare insurance, and some who have it may not even realize it. The high costs and shrinking choices faced by some people are real. But the fact is that many millions now have insurance because of the law. They are people all of us know: Our children and siblings and parents, our neighbors and colleagues and friends, those who are dealing with illness or job loss and would be uninsured but for the law that everyone loves to complain about.

No one has attacked Obamacare harder than Kentucky Gov. Matt Bevin, who ran last year on pledges to get rid of the state’s “unaffordable” Medicaid expansion and dismantle its successful online insurance marketplace. He’s not risking much if he does the latter, however, because Kentuckians will still be able to buy coverage through the federal marketplace. As for Medicaid, the new governor now says he will change rather than kill it. So coverage for 400,000 low-income people appears to be safe.

The Bevin saga underscores the emerging political realities of Obamacare. Millions are benefiting directly from it, and millions more know someone who is. No Republican will run on keeping and improving the law. But the first request of a new Republican president to a Republican Congress might well be: Please don’t send me an Obamacare repeal bill. Because then I’d have to sign it.

Jill Lawrence is the commentary editor of USA TODAY. Follow her on Twitter @JillDLawrence.

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