Republican politicians almost universally support repealing the Affordable Care Act in its entirety — even hinting that they’d like to replace the law with something that takes the situation as the ACA has left it and tries to repair it can draw accusations of perfidy. Given the myriad issues of the ACA and its poor approval ratings, this seems like it makes good politics and good policy — but does it reflect what Americans want? The latest Kaiser poll, which I mentioned below, suggests not quite:
As you can see, by far the most popular position is to keep the law but improve it. Even 26 percent of Republicans support the idea — as many, essentially, as want to repeal it entirely or replace it entirely. Improving the law in ways that fundamentally change it but technically keep it on the books — which is presumably what those 26 percent want — could have a similar practical effect to repeal-and-replace, so one could argue GOPers clearly favor that to repealing it entirely and doing nothing about health care thereafter. That’s to say nothing of the huge policy problems with trying to undo the whole law now or in 2017, when it becomes politically feasible. This puts Republicans in a tough spot when they do seize power — there’s a feasible coalition in there for legislating huge changes to the ACA and our health-care system, but it may involve disappointing more zealous Republicans, unless the GOP does a fantastic job of selling their alternative.
On the other hand, for now, the amount of royal blue on Kaiser’s survey suggests that Republicans could make the president’s resistance to almost any adjustments to the law — even substantial ones — an increasingly untenable position.
In fact, this poll has great news for 2014, in a way: The majority of Republicans want their party to do something dramatic about health care, whether that means getting rid of the ACA entirely or replacing it, while Democrats merely want their candidates to “work to improve it.” Is the latter really going to drive people to the polls? There’s some evidence some Democrats would want it to be “improved” in a more liberal direction, but given that bigger subsidies, more regulation, or a move toward single-payer is politically risible, what you actually have is a party that’s not very enthusiastic about defending the law, and don’t even seem satisfied with the president’s marginal, haphazard tweaks to it. Meanwhile, Republican cries to repeal or replace can easily motivate their base while peeling off some independents, which is enough to win a midterm election against a second-term president’s party.