A new National Journal survey finds that only 36 percent of adults favor repeal of the Affordable Care Act, while 30 percent would prefer to “wait and see” and another 27 percent would prefer to devote more resources to implement the law. Alex Roarty writes:
And when told that an independent Congressional Budget Office study had determined that repealing Obamacare would actually increase the deficit, a narrow plurality of respondents preferred to keep the law. On the question, 48 percent said “Congress should keep the program to expand coverage because it’s important to reduce the number of Americans without health insurance,” while 42 percent said “Congress should repeal the program to expand coverage because the government can’t afford it at a time of large budget deficits.”
This is the Republican challenge in a nutshell. The 42 percent that favors repeal of coverage expansion is overrepresented in the GOP primary electorate, yet Republicans need to secure some portion of the wait-and-see bloc to win a general election.
Roarty’s article brought to mind Ramesh Ponnuru’s critique of libertarian populism. Tim Carney and other libertarian populists champion attractive measures like deep payroll tax cuts. Yet unless these cuts are accompanied by tax increases elsewhere, e.g., on high-earners, whether via the payroll tax or the federal income tax or some other new revenue source, left-liberals can credibly claim that deep payroll tax cuts are incompatible with the benefits to which retirees have grown accustomed and which near-retirees have come to expect.
Similarly, it seems likely that once the ACA coverage expansion is entrenched, it will become difficult to reverse for the same reasons. We’ve discussed the fact that the ACA’s beneficiaries are disproportionately found among members of the Democratic coalition, which is in theory a source of political vulnerability. But it is also true that when the ACA benefits a member of one’s extended social network, it might incline one to be more supportive of it. That is, parents of adult children who benefit from ACA exchange subsidies might be more reluctant to support repeal. This is why it is important for Republicans to craft an alternative to the ACA, or reform of the ACA, as Avik Roy recommends, that can do a better job of meeting the underlying demand for affordable coverage expansion.