How to Get Republicans to Support the Affordable Care Act

First, the bad news. Democrats will lose the Senate in 2014 if they can’t figure out a strategy to support the Affordable Care Act.

Poll data backs this up and Democrats in competitive races like Mary Landrieu and Jeff Merkley look nervous. To mollify conservatives, they recently proposed a bill to let people keep their insurance plans for a year in response to Republican attack ads.

Every time Republicans yell “Repeal and Replace,” Democrats should shout: “We’re with you! Let’s expand Medicare for everyone!”

When has looking weak ever been good political strategy? They look primed for slaughter.

Now the good news. Republican strategy has never been more obvious: use the ACA as a wedge issue. Run this football up the middle until Democrats prove they can stop it.

Why is this good news? If Democrats can find a way to counter this single issue, the strategy falls apart. Unfortunately so far, their efforts haven’t been very effective.

Democrats are fumbling by getting mired in technical fixes to a poorly designed website. Don’t get me wrong, the website needs to be fixed but this isn’t much of a political strategy. As soon as one issue gets fixed, Republicans will find another issue.

Another flawed aspect of Democratic strategy: Every liberal I know recognizes that the ACA is a conservative solution. Why beat our heads against a wall trying to convince conservatives that a conservative solution is right for the country despite their now stated opposition?

The White House’s approach is slightly better. They want to focus on the economy. While I applaud this approach, Democrats still need an answer to health care because the media will drive the conversation; it is not going to simply avoid health care.

If we look at history, the answer is right in front of us.

There is one situation—and one situation only—in which Republicans support market-based health care reforms. It’s happened at several points in our history, but the conditions are the same. Republicans support market-based reforms when government-based solutions are on the table.

When the late Senator Ted Kennedy chaired the Health subcommittee in the early 1970s, President Nixon introduced an early version of the ACA called the Comprehensive Health Insurance Plan (CHIP) that included an employer mandate and subsidies for low-income families.

In 1989, Stuart Butler of the conservative Heritage Foundation introduced the individual mandate, the basis for Romneycare and Obamacare. Butler described why it was introduced:

Increasingly, pressure is building for some kind of national health insurance system in America. I believe that eventually the U.S. will have a “national health system,” in the sense of a system that assures each citizen of access to affordable health care. At issue is the kind of national system we should have.

It was created as an alternative to a government-run universal health care program or single payer (“Medicare for all”) as it is known today.

Butler’s ideas were used by Republicans in Congress in 1992 and 1993 as they sought an alternative to President Bill Clinton’s health care reform. The Health Equity and Access Reform Today Act (or HEART) was introduced by Lincoln Chafee and co-sponsored by 19 Senate Republicans including Bob Dole, Chuck Grassley, Orrin Hatch and Alan Simpson.

Are you sensing a pattern?

Republicans only support market-based reforms when single-payer programs look possible.

Instead of killing ourselves trying to explain conservative health care reform to conservatives every time they gin up outrage, we should be threatening to fight for single payer.

The beauty is that they’ve already generated the outrage. Every time they yell “Repeal and Replace” we should shout: “We’re with you! Let’s expand Medicare for everyone!”

I’m going to go out on a limb here and guess that the minute Democrats start taking up the cry for a single payer program, the conservative outrage machine dials back the anger.

Why don’t we attack instead of forcing liberals to defend a program we never wanted?

Imagine Democratic members of Congress actually having a response to Republican attacks on the ACA instead of limply trying to justify the solution.

It would sound like this:

There’ve been some early issues with the Affordable Care Act. We’re committed to making it better, but if it doesn’t work, we have proven alternatives. One is Medicare. I’m introducing a bill in the Senate this week to expand Medicare to everyone.

Then when Republicans vote for the 48th time to repeal the ACA (and yes, they’ve already voted 47 times to repeal!), hold a vote in the Senate to expand Medicare. Make Republicans explain why they’re not in favor of a better alternative.

It’s a no-lose scenario. Best case, we turn Republican outrage into a better program. While I don’t think this is likely, wouldn’t it be ironic if Republican-generated outrage led to single payer?

At the very least, we counter the anti-Obamacare outrage, fight for something we believe in, and show that Republicans aren’t really interested in better solutions.


David Akadjian writes under this alias for Daily Kos. Follow him @akadjian.