Are Republicans afraid that health care reform may prove popular?

Although the law is polling badly, so did other federal social insurance programs — until they were implemented

Margot Lee, a volunteer for Enroll America's Get Covered America campaign, organizes her materials before canvassing in Englewood, N.J., in July.
Michael Nagle/Bloomberg via Getty Images

WASHINGTON — Republicans can tick off myriad reasons they want to defund the Affordable Care Act (ACA). They say it will cause some premiums to rise, it is another example of the government meddling in the free market and restricting individual choice and it will put an undue burden on small businesses.

But some conservative members of the GOP, including Texas Sen. Ted Cruz, who embarked on a 21-hour speech on the Senate floor earlier this week to lay out his case against the law, have hinted at another reason they see the current fight over the budget and the debt ceiling as their last, best chance to stop the ACA. There is the possibility, they say, that the public might come to like the new benefits once the law is fully in effect.

"While the ultimate goal is to repeal the law in its entirety, defunding is a crucial step so we can stop the law from being implemented before Americans get hooked on the subsidies," Cruz told the online conservative publication The Daily Caller.

Sen. Roger Wicker, R-Miss., similarly indicated that it would be hard to repeal the law after the public had a chance to get accustomed to it.

"Anytime you get somebody used to a government program, there is a tendency to — for that program not to go away," he told NPR.

Wicker also said, "In the next two years, really, less than 10 percent of the American people will be on this type of subsidy. So I think there are going to be so many drawbacks that I don't see Obamacare getting exceedingly popular."

Polling consistently shows that even three years after its passage, the ACA remains divisive among the public. A New York Times poll released Thursday shows that 51 percent of Americans disapprove of the law. About 39 percent believe the ACA should be defunded or stopped in some other way.  

But there is a chance that public opinion might follow the polling trajectory of other federal social programs, which were deeply unpopular before implementation and ultimately became widely liked.

Before Medicare was created in 1965, a Gallup poll from July 1962 showed that just 28 percent of Americans held generally favorable views of President John F. Kennedy's proposal, compared with 33 percent who didn't know what to make of it and 28 percent who disapproved.

"Obamacare is a home run by contrast," said Michelle Diggles, a senior political analyst with Third Way, a center-left think tank.

Today Medicare is broadly popular, although some GOP lawmakers have led efforts to cut benefits.

A more recent example comes from Medicare Part D, a provision — championed by Republican President George W. Bush in 2003 — that added prescription-drug benefits to the program. In April 2005, just as the measure began implementation, only 21 percent of the public had a favorable opinion, according to polling by the Kaiser Family Foundation and the Harvard School of Public Health.

Democrats, for their part, said the program was designed to benefit private insurers and pharmaceutical companies. Today about 90 percent of seniors are satisfied with their prescription-drug coverage under Medicare, and in 2010, Democratic lawmakers, even those who were originally opposed, voted to improve Part D as part of the ACA by closing a coverage gap long lamented by seniors.

Some analysts predict that the health care law as a whole will go the same way.

"It really wasn't until people started to gain access to these new benefits and actually get this new coverage and needed medicines that people started seeing those tangible financial and health-related benefits. That is really what started to turn public opinion," said Sabrina Corlette, a professor at the Health Policy Institute at Georgetown University. "And I think the same will be true for the health coverage under the ACA."

Green eggs and ham

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Historically, politicians have stepped in and made fixes to benefit programs instead of trying to completely repeal or defund them.  

"As benefits kick in, the skepticism about a government program goes away as people interact with it," Diggles said. "There's always problems. There's always glitches. Something doesn't work out."

Others argue that the ACA is a completely different beast. To start with, the bill did not garner a single Republican vote when it was passed in 2009, whereas Medicare and Part D passed with bipartisan support. As a consequence, opponents of the health care law have been particularly ferocious.

"The prime difference for them is that Obamacare was rammed through a party-line support, which is why you're seeing the major debate over implementation and now defunding the law," said Chris Jacobs, a health care analyst for the conservative Heritage Foundation.

Corlette noted that after Part D was signed into law, legislators thawed and helped their constituents sign up for coverage.

"Even strong opponents participated in education campaigns," she said. "They went to town-hall meetings and made sure their constituents had what they needed to take advantage of the new benefits. It remains to be seen if the present-day opponents of the ACA will pivot from rhetorical opposition to a more pragmatic approach when constituents start calling their offices or knocking on their doors — 'What am I supposed to do here?'"

In addition, the law is being implemented at a time when the economy is fragile and there is worry that expanding the social safety net will add to the country's long-term fiscal problems. That was not the case when Medicare passed.

"There was this lavish sense there was money to do all this, and the cost estimates were very optimistic because we'll pay for it by the wealth that's going to emerge," said Edward D. Berkowitz, a professor at George Washington University who studies public-policy programs.  

Although hooked-on-subsidies rhetoric is not the most common among Republican lawmakers, a vein of conservative thinking holds that all government benefits breed a culture of dependency. Others point out, too, that no federal entitlement program, like Medicare or Social Security, has been rolled back after it's gone into effect.

"It's certainly more difficult when people are on the benefits and the subsidies start flowing," Jacobs said. "That political reality does make it more difficult, but we think there's a fiscal argument that sooner or later we have to get our house in order budgetwise."

Cruz, in his Senate speech Tuesday night, notably read Dr. Seuss' children's classic "Green Eggs and Ham" for his children to watch on C-SPAN before they went to bed. Sen. Chuck Schumer, D-N.Y., said he was struck by Cruz's choice of that particular bedtime story.

"'Green Eggs and Ham' has a moral: Don't criticize something, don't reject something, until you actually try it," he said. "Sam said he didn't like green eggs and ham for a long time. And then when he finally tried it, he liked it.

"Maybe Ted Cruz, once Obamacare occurred, might actually like it."

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