Democrats defect from Obamacare: meanwhile, the GOP learns to stop worrying and love Obama's signature legislative victory.

AuthorSuderman, Peter

FOR PRACTICALLY ALL of the Obama administration, the partisan battle lines over the Affordable Care Act were clear. Democrats j love it. Republicans want to kill it. End of story, right?

But at the end of 2016, as President Barack Obama prepared to leave office and the health care law entered another open enrollment period, something unexpected happened: Democrats stopped defending Obamacare. It wasn't despair over the law's fate in the hands of President Trump. The trend began when Hillary Clinton was still the presumptive winner.

In October, Minnesota's Democratic governor, Mark Dayton, complained publicly that although the health law had "many good features," it was "no longer affordable to increasing numbers of people." Around the same time, Democratic House Minority Leader Nancy Pelosi, whose determination to pass health care legislation helped push the bill over the congressional finish line in 2010, was asked on Meet the Press about the j high price of health insurance premiums under the law. "Let's see how it works, and let's improve it," was her response. She also noted, as she has before, that what she would really "love" is a single-payer system. Just three years before, as the law's coverage expansion kicked in, she had touted it as a path to "more affordability, more accessibility, better-quality care, prevention, wellness, a healthier nation honoring the vows of our founders of life, a healthier life."

Also in October came complaints from former President Bill Clinton about a provision of the law that provides financial assistance to individuals at between 100 and 400 percent of the poverty line. "The people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies," he said at a rally in Michigan. He called the subsidy scheme "crazy" and declared that "it doesn't make sense. The insurance model doesn't work here."

Clinton was stumping for his wife. And Hillary, who just a few years earlier had blasted Republicans as a "noisy minority" engaged in "bad politics" for their opposition to the law, wasn't doing much to defend Obamacare either. In the month prior to Bill's remarks, she had only mentioned the Affordable Care Act once in campaign trail speeches--somewhat unusual given the law's prominence--and then only when Obama was in the room.

After Bill's comments made news, Hillary issued a begrudging follow-up statement. "I've been saying we've got to fix what's broken and keep what works," she said, "and that's exactly what we're going to do."

This was the Democratic presidential nominee's defense of her predecessor's signature achievement, the most expansive and expensive piece of social welfare legislation signed in a quarter century: Keep the parts that work, and fix what isn't working. It was an acknowledgement, as if anyone needed it, that the law was broken and was no longer desirable in its current form.

To be sure, no Democrat would be signing on to any GOP repeal vote in the near future. The Democratic opposition is subtle. But it is real.

More and more, Democrats have stopped defending the actual legislation as it exists on the books and in the real world. Instead, they have started arguing in favor of what might be described as a hypothetical "good parts" version of the law. They defend the idea of Obamacare, of a government-granted guarantee of affordable universal coverage, rather than the whole legislation itself.

Donald Trump's inconsistent and often incoherent opposition to the law--he promised to repeal and replace it with some unspecified alternative--meant that Democrats did not have to respond to detailed Republican attacks on the system. Instead, pressure came from the legislation's real-world failures. From spiking premiums to dwindling plan choice to blatantly illegal payouts, 2016 was the year that Obamacare finally became indefensible.

TO UNDERSTAND WHY Obamacare went so wrong in 2016, you have to understand its history and design. Obamacare was always politically contentious. When debate over the legislation that would become the Affordable Care Act began in 2009, Republicans were unified in their opposition to the law. The public, too, was always wary: For essentially all of the health law's life, more of the public has opposed it than supported it. Committed Democrats were its only basis of support.

The law was challenged repeatedly at the Supreme Court, and though it survived, it did not remain unchanged. In particular, the Court altered Obamacare's expansion of Medicaid, the health program for the poor and disabled jointly funded by the states and the federal government, which was one of the two main ways that the law...

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