If the relative success or failure of the Affordable Care Act is the biggest variable affecting national (and to a large extent, state) politics in 2014, then the second biggest is how Republicans adjust to the law if it more or less succeeds in achieving most of its stated objectives. The best bet, of course, is that GOPers will ignore or deny success, but as I’ve noted in the past, there could be a growing temptation for conservatives to execute a sort of jiu-jitsu move and utilize Obamacare’s exchange structure as a model for privatizing and otherwise “reforming” Medicare and Medicaid. And indeed, you can see that sort of dynamic slowly developing in Republican-controlled states exploring big and radical Medicaid experiments in exchange for agreeing to a federally-financed expansion of basic eligibility categories.
Jonathan Chait suggests a slightly different scenario whereby Republicans won’t give up on fighting Obamacare, but will shift tactics in order to focus on the administration’s own efforts to make the law work:
If and when the law melds into the national fabric, the proximate Republican response will not be to adapt their policy ideas to it, but to denounce it as a kind of stolen law….Eleven Republican attorneys general have denounced Obama’s various administrative maneuvers to make the law functional as illegal. “It was powerful corporate America, with its influential lobbyists, that got an additional year to meet the insurance mandate — when individuals did not,” complains The Wall Street Journal columnist Kimberly Strassel, “It was the unions that got a reprieve from a health-insurance tax — when individuals and small businesses were left to pick up the tab.” The hapless Obamacare is slowly giving way to the devious Obamacare.
In the very long run, Obamacare may become a thing, like Social Security and Medicare, that Republicans initially predict will destroy the fabric of capitalism but eventually accept and then finally swear up and down they will not harm. In the shorter term, it will remain a bloody shirt. Obamacare will be Benghazi or the IRS scandal writ large.
The “bloody shirt” analogy (an allusion to the post-Civil War Republican strategy of reminding northerners to “vote as you shot” against a southern-dominated Democratic Party) is apt in that it is based on Republicans treating Obamacare as a self-evident act of infamy that is spawning others (i.e., all the “corrupt” and “imperial” actions being deployed to fix the law’s problems in the absence of Republican cooperation in Congress). But it’s worth remembering that the conservative movement’s goals in health care policy go beyond repealing Obamacare and extend to major “reforms” of the two big health care entitlements. Voucherizing Medicare and block-granting Medicaid remain central and almost universally supported pillars of the GOP’s agenda. At least some Republicans are sure to keep their eyes on that bigger prize instead of making Obamacare their sole boogeyman.