What a Break in the Obamacare Battles Could Bring

This was published as a Wall Street Journal Think Tank column on July 8, 2015.

The Supreme Court’s ruling in King v. Burwell defused a political and policy crisis over the Affordable Care Act, but how long any cooling-off period lasts, or whether one exists at all, could affect efforts to address remaining implementation challenges.

Shortly after the ACA ruling was announced, Hillary Clintons 2016 campaign sent out a fundraising email, warning Americans that “Republicans running for president still want to take basic health security away from millions of Americans.” Jeb Bush‘s campaign solicited contributions about as quickly, warning that the president “forced ObamaCare on the American people in a partisan and toxic way” and that “we both know that Hillary Clinton will be more of the same.” There’s a message implicit in these e-mails: It may be only a brief time before the Affordable Care Act heats up again as an issue in the 2016 election cycle. That doesn’t mean it will move a lot of votes, but it will generate heat and could affect turnout at the margins.

A cooling-off period could provide an opening for some red states to consider expanding their Medicaid programs and to negotiate the terms of waivers with the Department of Health and Human Services that conservatives in these states may want to make expansion more politically acceptable to them. Less controversy around the ACA would also enable efforts to enroll the remaining uninsured to proceed unimpeded by the negative coverage, confusion and misperceptions that often flow from political warfare about the health-care law. This matters because signing up more people not only helps achieve broader goals of coverage expansion but also would help stabilize  premium increases in the marketplaces by enlarging the risk pool. A cooling-off period might also provide more space for bipartisan efforts in Congress to reach agreement on changes to the law (even if the chances of that happening are slim). Democrats and Republicans agree on very little when it comes to the ACA, and it’s hard for Republicans at the national or state level to compromise when they and their party are campaigning against the law or know that they will be soon.

Political attacks can take a toll on the law and sour the policy environment. Consider a shift that occurred during the Republican presidential primaries in 2011. The gap between favorable and unfavorable opinion on the law was dead even that April. In October, after GOP candidates had railed against the law for months on the campaign trail and in televised debates, the gap had widened to 51% against the ACA and 34% for it.

Not every Republican presidential candidate will focus on the ACA with equal fervor–just as they have taken different stances on same-sex marriage–but many are likely to strongly oppose it, if only to curry favor with ACA opponents and party activists.

On the Democratic side, where support for the law is strong but less intense than the opposition on the right, candidates can be expected to focus on improvements to the ACA and on pocketbook health-care issues that resonate with middle-class Americans such as affordability of high-cost drugs. One goal will be to move beyond the ACA so that Democrats have something new to offer on health care.

In the 2016 cycle, candidates’ health agendas are likely to skew right and left as campaigns aim primarily to turn out the base in the general election rather than searching for votes among an ever-shrinking pool of genuine independents.

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