Tune Changing

08.28.13

Why Republicans Are Starting to Love Health Reform

Turns out a lot of Republicans love Obamacare, reports Daniel Gross. Or at least, they like coverage for their kids, health-care rebates and a ban on denying coverage for preexisting conditions.

The Affordable Care Act, known as Obamacare, is starting to take effect. And here’s a shocker. While the overall legislation is wildly unpopular among Republicans—90 percent disapproved, according to a June poll—individual components seem to be catching on like wildfire among the GOP crowd.

Take, for example, the requirement that insurers continue policies to children whose parents have coverage until they turn 26. The Commonwealth Fund last week released an interesting study (PDF) of young people and Obamacare. It found that between 2011 and 2013, the number of people aged 19 to 25 who had been on a parent’s health insurance plan in the previous year rose from 13.7 million to 15 million. “Of the 15 million young adults on a parent’s plan, an estimated 7.8 million likely would not have been eligible to enroll in that plan prior to the Affordable Care Act,” the Commonwealth Fund reported. The report also found that Republicans were more into this provision of the ACA than Democrats. In March 2013, 73 percent of young Republicans surveyed had heard of the provision, compared with 63 percent of Democratic youths. Maybe it’s because they were more likely to be benefitting from the expansion. “In March 2013, 63 percent of Republican young adults had enrolled in a parents’ policy, compared with 45 percent of Democrats,” the report said.

That’s a pretty significant difference. What accounts for it? It could be that young Republicans are less likely to leave the nest and get their own jobs with benefits than young Democrats. Or it could be that Republicans simply love their kids more. But it is more likely that Republicans, being generally better off than Democrats, are more likely to have solid employer-based health insurance in the first place. The kids of well-off people don’t typically enter the workforce or the military at the age of 18. They go to college, then take a gap year, or go to graduate school, or try to get in on the ground floor of professions like media, entertainment, politics, and finance by taking a series of internships, or part-time jobs, or volunteer jobs, none of which may come with insurance. And so the (likely) Republican parents of Republican youths aren’t making their kids take out health savings plans or buy crappy high-deductible plans, or simply fend for themselves—as most Republican politicians think everybody else’s kids should do. Thanks to Obamacare, the grown-ups are putting their kids on their insurance plans.

In the old days, they used to say that a conservative is a liberal who has been mugged by reality. When it comes to health insurance, it seems a liberal is a conservative who has been mugged by an illness.

Rebates are a second, apparently non-objectionable component of Obamacare that has already kicked in. The ACA set standards for the insurance industry, stipulating that firms must spend a certain amount (80 percent) of the premiums they collect on patient care. Under Obamacare, insurers that choose to spend more money on administration, or marketing, or salaries, or dividends have to send rebates to customers. This summer, the first rebates were sent out, some $500 million to 8 million Americans. Now, these rebates are likely to have been shipped disproportionately to Republican households—those with high-end, employee-subsidized coverage. But I haven’t been able to turn up any examples of people refusing thechecks, or sending them back, or burning them—an act FreedomWorks is suggesting people do to their fictional “Obamacare cards.” (If you did burn your Obamacare rebate check, please tweet at me: @grossdm I’d love to speak with you.) Republicans, like Democrats, enjoy receiving checks in the mail.

Then there’s the case of pre-existing conditions—another aspect of Obamacare that is popular among some Republicans. In the old days, they used to say that a conservative is a liberal who has been mugged by reality. When it comes to health insurance, it seems a liberal is a conservative who has been mugged by an illness. After having a devastating stroke in 2012, Sen. Mark Kirk had an epiphany about the inadequacy of rehabilitation services for poor people. “My concern is what happens if you have a stroke and you’re not in the U.S. Senate, and you have no insurance and no income,” he told National Journal. “That’s the question I have been asking, and the reality is that if you’re on Illinois Medicaid and are a stroke survivor, you will get just five visits to the rehab specialist.”

The same holds for the pre-existing condition ban. Clint Murphy, a former political operative, McCain campaign staffer, and cancer survivor turned Georgia real estate agent, recently wrote of his conversion on Obamacare. Although he had long since been cancer free, Murphy still wasn’t able to get insurance as a self-employed person. “I have sleep apnea. They treated sleep apnea as a pre-existing condition. I’m going right now with no insurance,” he said. Murphy said he can’t wait for the exchanges to bet set up in Georgia, so that he’ll be able to purchase insurance without being denied for a pre-existing condition. And even as they cavil about ripping up Obamacare, and hence the ban on pre-existing conditions, it is common to hear some Republicans speak kindly of the ban.

This is a dynamic we’ve seen over and over again in the past 80 years. Republicans shriek, cry socialism, and offer full resistance to any effort to expand social insurance. Then, after a certain amount of time passes and social insurance measures become popular and effective, they stand foursquare behind them and demand they be protected. Every single stinking component of FDR’s New Deal was a disaster, but don’t you dare touch Social Security! Lyndon Johnson’s Great Society program was a debacle, but keep the government out of Medicare! Obamacare must be torn up root and branch, just don’t kick junior off my insurance plan!

It almost seems as if much of the political toxin could be removed from the debate if Republicans could somehow be kept ignorant about the party affiliation of the president who first proposed the plan.

To this point, there was a great anecdote in a recent Washington Post article about efforts to pitch state-level exchange programs at the Kentucky State Fair:

“A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare. The man is impressed. “This beats Obamacare I hope,” he mutters to one of the workers.”

The person running the booth didn’t have the heart to tell the guy that the program he seems to like is Obamacare.