It’s Time for Democrats to Embrace Obamacare

Paul Begala is right. “Democrats shouldn’t try to spin this loss,” Begala, a veteran political consultant, tweeted after it became clear that the Republicans had won a keenly contested special election for a vacant seat in Florida’s 13th District, which runs through Pinellas County, on the Gulf Coast. “We have to redouble our efforts for 2014. Too much at stake. #noexcuses.” The Democratic contender, Alex Sink, a former gubernatorial candidate, had experience and strong name recognition; the Republican, David Jolly, was a little-known former lobbyist. Despite the endorsement of Begala’s former boss Bill Clinton and other leading Democrats, Sink came in second—largely because her opponent, with the aid of well-financed Republican groups, portrayed her as a poster child for the Affordable Care Act.

The G.O.P. campaign was straightforward and unrelenting. In one campaign ad (cited by Alex Isenstadt, of Politico), Jolly said, simply, “She supports Obamacare. I don’t. I’m David Jolly, and I approve this message because Pinellas needs someone to look out for our interests.” Another ad claimed that Sink’s loyalty was to President Obama and Nancy Pelosi rather than to Florida, adding, “Why else would she continue to support Obamacare?”

As Yahoo’s Chris Moody noted, the election wasn’t a bellwether contest—special elections rarely are—but a test of each party’s messaging as the mid-term elections approach. Faced with the G.O.P. barrage, Sink tried to change the subject from the Affordable Care Act to protecting Medicare and Social Security from Republican privatization efforts, which she said Jolly supported. (In a dispatch from the district entitled “Obamacare’s Ground Zero,” David Weigel, of Slate, provided a good account of Sink’s troubles.) When pressed, as she was frequently, she equivocated, saying that she supported parts of the health-care reforms, such as forcing insurers to enroll people with preëxisting conditions, but that she also believed it needed fixing in ways that she couldn’t readily specify.

Trying to pussyfoot around Obamacare was an awkward strategy, and, evidently, it didn’t work. If other Democrats are to avoid meeting Sink’s fate in November, they need something more convincing to say about the Affordable Care Act than “mend it, don’t end it,” which is now their default position. But what could that be?

Here’s a heretical idea. Rather than parsing the individual elements of the law, and trying to persuade voters on an à la carte basis, what about raising the stakes and defending the reform in its entirety as a historic effort to provide affordable health-care coverage to tens of millions of hard-working Americans who otherwise couldn’t afford it? Instead of shying away from the populist and redistributionist essence of the reform, which the White House and many Democrats in Congress have been doing since the start, it’s time to embrace it.

What would that mean? It would involve reaching out to the Democratic Party’s core voters—lower-income people, minorities, highly educated liberals—and portraying Obamacare as the fulfillment of the great human-rights project that began in the nineteen-thirties, under Franklin D. Roosevelt, and was expanded during the nineteen-sixties, under Lyndon Johnson. That message wouldn’t merely be more honest; it would be more effective in getting Democratic voters to turn out in November, which is essential if the Party isn’t to suffer a repeat of 2010.

To be sure, Social Security and Medicare aren’t often described as human-rights reforms, but, make no mistake, that’s what they were. They were based on the notion that elderly Americans, regardless of race, income, or creed, have a right to avoid destitution and be treated for their illnesses. Similarly, the premise of the Affordable Care Act is that Americans of all ages, regardless of their incomes and personal histories, have a right to receive medical treatment. You don’t see Republicans campaigning against the public retirement programs—not openly, anyway. Despite the widespread belief that voters don’t like big government, G.O.P. candidates know, to their cost, that Social Security and Medicare are sacrosanct. Over time, universal health coverage will probably come to be seen in the same way. But it might not happen unless the architects of Obamacare stand up for it more vigorously.

The reform isn’t ideal. Parts of it, such as the employer mandate, have been delayed. The reform of individual coverage, for political reasons, is built on subsides for the purchase of private insurance policies, which is expensive, complicated, and, often, frustrating. The rollout of the new federal insurance exchange was horribly botched. But that was months ago. Today, more than four million people have selected private health-care plans through the federal and state exchanges, a number that, according to Tuesday’s update from the Department of Health and Human Services, is about three-quarters as many as the Obama Administration originally wanted. Given the technical problems the exchanges have experienced, and the deluge of criticism heaped upon them, that’s a much better outcome than could have been anticipated before Christmas.

Moreover, the 4.2 million enrollment figure doesn’t include people who have enrolled in Medicaid, which, in states that chose to participate in the reform, is now available to households that earn less than a hundred and thirty-three per cent of the poverty line. We won’t know until the end of this month just how many low-income families have taken advantage of the new eligibility limits to enroll, but it could well be more than the number who have signed up for private insurance. As the March 31st deadline for enrolling approaches, a number of states are reporting that they are exceeding their Medicaid goals.

In Washington State, which operates an online exchange called Washington Healthplanfinder, more than two hundred thousand newly eligible adults had enrolled by March 1st. That’s well above the state’s original target of enrolling about a hundred and thirty-six thousand people by April 1st. And it doesn’t include another hundred thousand new Medicaid enrollees who were previously eligible but hadn’t signed up. “Those were people they were never able to connect with until we started marketing Healthplanfinder,” Michael Marchand, a senior official at the exchange, told the A.P.

Washington, in fact, provides an interesting study of how the entire Affordable Care Act may play out in states that are participating in it fully. Before the law took effect, the state estimated that about a million of its residents didn’t have any health coverage. Today, state officials reckon that about four hundred and twenty-five thousand of these people now have some sort of coverage. From where I sit, a forty-per-cent reduction in the uninsured population in six months isn’t bad going.

Finally, it bears repeating that, previously, most of the newly insured were people who, until then, simply couldn’t afford health care. Now, thanks to the generous financial assistance available through the insurance exchanges, families who earn, say, fifty or sixty thousand dollars a year—roughly the median income—can purchase insurance, and peace of mind, without having to forego other essential expenditures. The update from the Department of Health and Human Services revealed that eighty-three per cent of the people who have selected insurance plans are eligible for subsidies. We can debate the cost to the taxpayer of these subsidies, which, in some cases, can run to eight or ten thousand dollars a year. As I have done in the past, you can talk about whether other approaches, such as a public-insurer option, would have been cheaper and more efficient. But it’s undeniable that, for many hard-pressed households, the Affordable Care Act has lived up to its name by making health care more affordable.

About the only Democrat I’ve heard pressing this argument is Katherine Sebelius, the embattled Secretary of Health and Human Services. Many other Democrats, although well aware of the messaging problem, remain wary of being tagged as liberals and redistributionists.

In some districts, where Democratic candidates are busy wooing independents or Republicans, this is understandable. But in many races—and this is something that David Axelrod, President Obama’s former campaign strategist, acknowledged in his Florida postmortem—the key to victory is turning out the Party’s core voters. What better way to do it than by turning Obamacare into a great progressive cause, rather than something to avoid or be embarrassed about.

Above: The Democratic congressional candidate Alex Sink speaks during a forum in Clearwater, Florida. Photograph by Brian Blanco/Corbis.