Obamacare's huge turning point: How a nomination hearing signals GOP epiphany

New HHS secretary's nomination hearing was once expected to be a lambasting for Dems. Here's why it didn't happen

Published May 9, 2014 11:44AM (EDT)

                                                        (Jeffrey Malet, maletphoto/Reuters/Jason Reed)
(Jeffrey Malet, maletphoto/Reuters/Jason Reed)

We were promised war. Last month, after President Obama nominated Sylvia Mathews Burwell to replace departing Health and Human Services Secretary Kathleen Sebelius, Republicans told anyone who would listen that they would seize the opportunity to once again fulminate about the evils of the Affordable Care Act. This spectacle, it was thought, would put already vulnerable Democrats in an awkward position as they’d have to once again take sides in the fight over the disastrously unpopular law.

“Republicans hope to turn Sylvia Mathews Burwell’s nomination to run the Department of Health and Human Services — announced by President Barack Obama on Friday — into a proxy war over Obamacare,” reported Politico on April 11.

“Republicans have made it clear they won't pass by this midterm election-year opportunity to highlight all of the Affordable Care Act's problems,” noted CBS News.

Even Democrats were convinced that Republicans would put Burwell through the wringer. “They’ll be bound and determined to make as much hay out of a confirmation process as they can as they try to put the program in the worst possible light,” former Harry Reid aide James Manley told Bloomberg Businessweek.

And so yesterday, when Republicans on the Senate Health, Education, Labor, and Pensions Committee got their chance to put Burwell and the Affordable Care Act on the hot seat, the questioning ended up being ... pretty damn boring, actually. The Republicans just don’t seem as confident in their anti-Obamacare obsession as they used to be.

There’s a good reason why. Between Obama’s nomination of Burwell and yesterday’s hearing, Obamacare’s problems started disappearing. The ACA met and exceeded its goals for the first open enrollment period. We found out that the vast majority of people who signed up for coverage actually paid their premiums. The uninsured rate dipped dramatically.

The Republicans have also been dealing with some Obamacare P.R. fiascoes. A House GOP report claiming a low rate of premium payments for Obamacare enrollees was swiftly and very publicly debunked. The day before Burwell’s hearing, House Republicans were embarrassed after health insurance executives they’d called to testify to the ACA’s failures instead showed up and kicked the legs out from the GOP’s critiques of the law.

Take all that together and you can understand why Senate Republicans lacked the ammunition and/or the inclination to put the screws to Burwell.

Instead, ranking member Lamar Alexander used his opening statement to give a tepid, pro-forma attack on the law while offering the Republican bromides of “more choice” and “more freedom” as alternatives. His message to the nominee? “Ms. Burwell, you have a reputation for competence. And I would respectfully suggest you’re going to need it.” John McCain, typically an ornery and irascible critic of anything linked to Obama, stopped by to dump an almost embarrassing heap of praise on Burwell. (Though he did joke that Burwell was taking over as captain of the Titanic after it had struck the iceberg.)

You can tell Republicans are really going to miss having Kathleen Sebelius to kick around. In the past, Senate Republicans have had little problem stirring up phony controversies about President Obama’s high-level political appointees, but Burwell’s résumé and good relationship with Capitol Hill make her a difficult target, even as she assumes control of a healthcare law Republicans love to hate.

The flip side to the Republicans’ lack of fire was the degree to which Democrats on the committee vociferously defended the Affordable Care Act. Most noteworthy among them was Kay Hagan of North Carolina, widely considered the most vulnerable Senate Democrat this election cycle.

Recall that a month ago, the conventional wisdom was that vulnerable Democrats would be put in a tough spot by Burwell’s hearings because Obamacare would be back on the front pages. And yet, Hagan used her time to question Burwell about expanding Medicaid under the Affordable Care Act, noting specifically that the state Legislature in North Carolina had blocked the Medicaid expansion:

"Last year, in North Carolina, our state legislature and governor decided against expanding the state’s Medicaid program, and as a result, about 500,000 people who would have qualified for coverage through Medicaid are now not able to do so. […] Director Burwell, can you compare the experience of states that have expanded their Medicaid programs to those that haven’t, commenting specifically on the health of newly eligible enrollees and whether there’s any increased cost for states or health providers like hospitals?"

The content and timing of Hagan’s question are noteworthy – the man who led the North Carolina House of Representatives in opposing Medicaid expansion within the state, Thom Tillis, just won the Republican nomination to challenge Hagan in November. Hagan’s campaign against Tillis to date has been awkward. Before the GOP primary she tried to move against Tillis on Obamacare from the right, airing a misleading ad that quoted Tillis calling Obamacare “a great idea.” It was likely intended to drive conservatives away from Tillis and force a runoff in the primary. That didn’t happen, so now she has to transition to a general election strategy.

Her focus on expanding Medicaid makes sense, as it's one of the more popular parts of Obamacare and safer ground for Democrats this cycle. In North Carolina, 54 percent of voters back the expansion of Medicaid, according to a New York Times poll from last month. Of course, there’s no guarantee that strategy will work. North Carolina’s political climate is particularly treacherous for Democrats in midterm elections, and even the savviest messaging on Obamacare may not be enough to overcome the structural disadvantages Hagan faces.

Even still, her questioning at Burwell’s hearing, and the Republicans’ wan performance, represent a flipping of the Obamacare script from a month ago, when it was assumed that aggressive Republicans would have uncertain Democrats on the defensive. There’s still one more hearing to go, and it’s possible that it will provide more fireworks than yesterday’s snoozer, but everything that’s happened in the past month should make clear that Obamacare’s political trajectory has been altered significantly.

By Simon Maloy

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