There are two things you should know about Sen. David Vitter, and one of them is that he really hates Obamacare. The Louisiana Republican spent months in 2013 gumming up non-Obamacare-related legislation in an effort to end federal subsidies for Capitol Hill staffers to buy health insurance. His obsessive quest irked lawmakers on both sides of the aisle who weren’t keen to force their staffs to pay more out-of-pocket for their health coverage. Democrats finally got fed up and told Vitter that if he didn’t quit it, they’d start bringing up the other thing you should know about David Vitter.
Anyway, with Vitter on record as a die-hard opponent of federally subsidized health insurance, it was a bit of a shocker this week when he showed up at the Press Club of Baton Rouge and said maybe he’d be open to accepting federal dollars to expand Medicaid in the state. “We need to improve and reform Medicaid, and I want to look at everything that could be brought to bear to do that. Now, could more federal resources help to do that? They could, if it's done right and if it's done in a constructive way.”
From a crass political standpoint, it makes sense for Vitter to ease into bed with Obamacare’s Medicaid expansion. He’s running for governor, and expanding Medicaid would mean lots of Louisiana residents receiving health coverage at relatively little cost to the state. Republican governors nationwide have been slowly coming to the same realization. But the fact that David Vitter, of all people, is adulterating his rigid opposition to the Affordable Care Act is just the latest indication that the much-maligned law is working, and working well.
I wrote a couple of weeks ago about how June was shaping up to be a bad month for Affordable Care Act opponents, and it’s only gotten worse for them since then. A new report from Health and Human Services found that people who were eligible for subsidies and shopped for health insurance on Healthcare.gov paid an average of $82 monthly for their insurance premiums. The report also found that “82 percent of people eligible to purchase a qualified health plan could choose from 3 or more health insurance issuers, and 96 percent could choose from 2 or more health insurers in the Marketplace.”
The whole idea behind Obamacare was to provide incentives for insurance companies to participate in the marketplaces, and foster competition among them to keep prices down. The exchanges have been successful enough that insurers who opted out of the first enrollment period are reversing course and will offer plans through the federal exchange next year.
Those who’ve been enjoying Obamacare’s benefits for years now – the young people who were allowed to remain on their parents’ insurance until age 26 – are reporting better health outcomes and reduced expenses. And the Obamacare “sticker shock” that so many conservatives were sure was coming has not yet materialized. A study conducted by a conservative economist found that people who’d been purchasing their own health insurance and then switched to Obamacare saw their premiums rise between 14 and 28 percent – not exactly a tremendous jump. Also, the study didn’t take into account Obamacare’s subsidies for lower-income families.
When you put all these developments together, it starts to become clear that for opponents of the ACA, everything is going wrong. They said out-of-pocket costs would skyrocket, they’re actually pretty low. They said premiums would jump by triple digits, but the increase has been far less. They said the law would sink into a death spiral and insurers would flee, but they’re signing on in greater numbers. Republicans across the country are buckling in their resistance to expanding Medicaid and making it that much more difficult for the holdouts to justify their obstructionism.
At the same time, Republicans in Congress are having trouble mustering the sort of outrage that came so easily during Obamacare’s shambolic rollout, and are instead spending their time getting into fights with faceless government number crunchers. The House Oversight Subcommittee on Economic Growth, Job Creation & Regulatory Affairs released a study yesterday claiming that Obamacare will preside over a “bailout” of health insurers that would cost over $1 billion. The study was intended to rebut the Congressional Budget Office, which found that the program in question was actually revenue neutral (it’s also not a “bailout”). But as Jonathan Cohn notes, even if the GOP study were accurate, $1 billion in the context of Obamacare’s overall spending levels is actually a very small amount of money and really not worth getting in a twist over.
But that’s what Republicans have left in their arsenal – small-bore critiques that do, at best, glancing damage. Eric Cantor promised at the beginning of the month that the House would take up a non-specific Republican alternative to Obamacare at some point in June, but then he lost his primary and announced his resignation as majority leader. What effect that will have on the Republican agenda is yet to be seen.
Either way, the Republicans are in an awkward position and seem to be adrift strategically. It feels like they never even considered that the Affordable Care Act could actually work, and now that it is, they don’t really know what to do.