When former Obama adviser and campaign manager David Plouffe said on Sunday that running against Obamacare would be an “impossibility” for Republicans, his reasoning seemed dubious. By the fall of 2014, Plouffe insisted, “millions of people will be signed up,” and Republicans would struggle to convince them to give up their new insurance. While those figures seem optimistic, Plouffe’s argument should not be dismissed.
Democrats designed Obamacare to be repeal-proof. They followed the advice of veteran Chicago strategist (and convicted felon) Robert Creamer, who wrote Democrats’ political blueprint for passing “universal health care” in 2006-7, partly while he was serving time in federal prison for bank fraud and tax evasion. The idea was to use health care reform as the first in a series of sweeping, “progressive” changes in America.
Throughout the Obamacare fight in 2009 and 2010, Creamer admonished Democrats that their electoral fortunes depended on their ability to pass the bill and motivate Obama’s core supporters: “[H]istory tells us that if Obama doesn’t deliver on things like health care reform, his numbers and the Democratic brand will sink and leave many Democratic candidates for Congress looking for other lines of work,” he wrote.
What Creamer overlooked, of course, was that many of the Democrats who voted for Obamacare were from relatively conservative districts, including some that had only recently been poached from Republicans in the 2006 midterms. By following his advice, Democrats lost the House–and also lost several state legislatures, allowing the GOP to redraw districts and dash Obama’s dreams of a permanent progressive majority.
Yet Creamer–who advised the Obama campaign in 2008 and assisted in grassroots efforts in 2012–remained confident about Obamacare’s prospects, despite the law’s unpopularity. When the Supreme Court upheld the law in June 2012, Creamer published an exultant column at the Huffington Post listing the ways in which “Democrats can now move from defense to offense on health care”:
By supporting repeal of the entire law, Republicans also support taking away the law’s protections against discrimination because of pre-existing conditions.
They support taking away access to free preventive health care for seniors.
They support taking away health care from millions of young people who can now stay on their parent’s insurance policies until they are 26 years old.
They support taking away access to contraception for women.
They support taking away enhanced prescription drug coverage for seniors.
They support taking away provisions that no longer allow discrimination against women.
They support taking away provisions that prevent people from being just one serious illness away from bankruptcy.
The [sic] support ending provisions that require that insurance companies can must spend 80 percent of their premium dollars on medical care — not on administrative costs and profits.
Note that none of the above provisions mentions expanding health insurance to the uninsured–the original “crisis” that Obamacare was supposed to solve. Nor did Creamer say anything about the success of the new Obamacare exchanges. The most important part of Obamacare, to Obama’s inner circle, was passing a laundry list of smaller benefits that would make the law much more difficult to repeal even if the policy did not work.
As Creamer put it: “People may be afraid of things they don’t know much about. That helps explain some of the past opposition to the health care law by people who would benefit from it. But people are furious when you try to take something away from them.” That “something” was not Obamacare as such. It was the additional benefits that the Affordable Care Act provided, and which are now the law’s last line of defense.
Democrats rushed the bill through Congress because they knew it did not have to be perfect. It did not have to satisfy the left’s demand for a “public option,” and it did not even have to work (which is also why Obama neglected its implementation). As Creamer advised, the Affordable Care Act was “a starter house that can be expanded.” Once in place, it could only be expanded. It would never be destroyed. Republicans wouldn’t dare.
“If, once it is passed and signed into law, the Republicans want to campaign to repeal health care reform I say, go ahead, make my day,” Creamer wrote (original emphasis!). Not only would it be hard for the GOP to fight against the ideal of universal health insurance, but it would be difficult to reverse any new benefits the law created–such as the expansion of Medicaid, which, not coincidentally, is the only successful part of the rollout.
It is not possible to accept the new Medicaid funds on the one hand, as some Republicans have done, and still claim to oppose Obamacare on the other. The law’s marginal benefits are the key to blocking repeal. That is Democrats continue to say the party will run on Obamacare, and why Plouffe thinks running against it is an “impossibility.” They are framing the new benefits as a form of “health security,” an irreversible entitlement.
Republicans might find enough Democratic votes for repealing Obamacare if they could find a way to preserve the new benefits. The president knows that. That is partly why he continues to resist any legislative changes to his signature law: they would open the door to separating the benefits from Obamacare’s fraudulent insurance scheme. Indeed, the White House is already arguing that the benefits are themselves integral to the law.
Running against Obamacare is not an “impossibility,” and if Plouffe manages to convince Democrats that it is, the way Creamer advised them in 2010 that their careers depended on Obamacare’s passage, Republicans will win yet another sweeping midterm victory. But that will not, by itself, solve the problem of how to deal with the law’s “repeal-proof” provisions, as long as a Democrat wields the veto pen. And 2016 is not looking good.