Without Massive Republican Opposition, Obamacare Would Be in Better Shape

To help people sign up for coverage, the Affordable Care Act provides federal dollars for “navigators,” community-based groups that help individuals enroll in the exchanges. They are a real boon to efforts to implement the law, which means they’re a target for Republican efforts to derail Obamacare and create more problems for the administration.

To wit, Dylan Scott reports for Talking Points Memo, Senate Republicans are using the lack of a federal background check for navigators—the groups themselves are responsible for vetting their employees—to attack the entire program as a vector for felons, identity thieves, and other criminals. “Americans who’ve lost their insurance and find themselves forced onto the exchanges—the last thing they need is to worry about some felon stealing their identity,” said Senate Minority Leader Mitch McConnell, criticizing the community groups that have stepped in to help confused consumers. Likewise, here is Texas Senator John Cornyn:

“It is simply astounding that the administration is urging the American people to give their Social Security numbers and sensitive personal information to people who have not been properly vetted,” Cornyn said on the Senate floor. “We need to also dismantle the navigators program before it unleashes a wave of fraud and corruption.

For my part, I’m both astounded by GOP efforts to smear groups like the United Way, and unsurprised. If Republicans have shown anything over the last four years, it’s that they’ll do anything to stop the Affordable Care Act, even if it amounts to legislative sabotage.

Indeed, what’s frustrating about the current conversation over Obamacare is the extent to which there’s been collective amnesia regarding the GOP’s categorical opposition to the law. Pundits who see the problems with Healthcare.gov as an indictment of “big government liberalism”—or, as Ross Douthat put it, evidence of “The welfare state’s ability to defend itself against reform”—neglect to grapple with the concrete consequences of the GOP’s monomaniacal crusade against the Affordable Care Act. How would the status quo look if Republican states embraced the Medicaid expansion and worked to build their own exchanges (see the success in Kentucky, for instance)? What if, instead of casting endless repeal votes, GOP lawmakers worked with Democrats to fix problems in the law? And what does the political situation look like in a world where Republicans don’t attack the Affordable Care Act as a step on the road to serfdom?

In this alternate world where conservatives care about governing, Obamacare has its issues, but—with working state exchanges and a full Medicaid expansion—it’s more stable and popular than it is now. Or, put another way, the problems with the law are far more a function of politics than “liberalism” or any other ideological concern.

None of this is to say Republicans should support the law like Democrats. But disagreement doesn’t require the quasi-massive resistance of the last few years. It was—and is—possible for Republicans to oppose key parts of the law, and work for reforms that move the ideological needle in their direction. For instance, in Arkansas, Republicans (led by a Democratic governor) are using funds from the Medicaid expansion to extend subsidies to lower-income residents, so that they can purchase insurance on the exchanges. Yes, the state is unwilling to expand a government program, but it will do more to subsidize private health insurance.

In other words, there's nothing that substantively precludes other Republican states from using the law’s flexibility to pursue their own ends. If conservatives could let go of their Obama hatred and partisan pique, they might see the real opportunities that exist for center-right health reform. Of course, given the last two months of political drama–including the month-long game of chicken over defunding the Affordable Care Act—I'm not about to hold my breath.