WaPo’s Greg Sargent goes through the useful if complex exercise of “envisioning” a future when Republicans have accepted the Affordable Care Act as a fait accompli rather than as the Great Satan, and are willing to negotiate over its details in ways that benefit both parties’ interests. He presents it as a three-step process; the first two are basically just the acknowledgement that the demand to repeal Obamacare isn’t the political no-brainer they’re treating it as right now. It’s Greg’s Stage Three of Obamacare Acceptance that’s more interesting:
Republicans accept Obamacare is likely here to stay, abandon the premise that the only acceptable outcome is crippling or eliminating the law, and negotiate to achieve incremental changes they want… It’s hard to know when this might happen in earnest – certainly not in 2014, and GOP presidential primary politics could also make this difficult next year. But you’re already seeing this a bit with GOP governors who are negotiating with the feds to create their own versions of the Medicaid expansion.
He’s right that the interest of a handful of Republican governors in accepting vast federal sums to finance conservative-style Medicaid “reforms”–from utilization-discouraging copays to privatization of services–is a potential signpost, as suggested nearly a year ago by conservative wonks Douglas Holtz-Eakin and Avik Roy in arguing that the private-insurance basis of Obamacare could lead to the privatization of Medicaid and Medicare. But it’s hardly a stampede, and won’t necessarily prevail any more than the provider pressure that a lot of observers confidently and erroneously predicted would make the Medicaid expansion sweep the red states.
Nationally, and at the federal level, it’s hard to see any warming trend towards Obamacare on the Right in the immediate future, so long as any constituency theoretically disgruntled by the law can still be mobilized, or any boogeyman fear can be aroused. There is no question the 2016 presidential nominating process will create enormous pressure on ambitious Republicans to intensify their Just Say No views. So I tend to agree with Kevin Drum:
Obamacare could be different if it becomes widely used by the middle class, not just the poor. Republicans would have a hard time resisting middle-class demands to improve the program. But that’s what it will take. And I’d guess that 2017 is about the earliest likely date for Republicans to give up their dream of total repeal.