If GOP holds the House, Affordable Care Act is toast

On Wednesday, Virginia’s legislature voted to expand Medicaid, accepting a key piece of the Affordable Care Act. Around 400,000 people will gain coverage.

The politics of the move aren’t hard to understand. Virginians overwhelmingly support Medicaid expansion; last fall, Democrat Ralph Northam won the governorship by a landslide after a campaign largely focused on health care. But wait: Don’t we keep hearing that Democrats are running on nothing except opposition to Donald Trump?

Anyway, the will of the people on health care is clear: Whatever qualms voters may have had about Obamacare, a strong majority want to keep and expand the gains in coverage that America has achieved since the law went into effect.

In other news, there are multiple reports that Republicans in Congress may make another attempt at repealing the ACA this summer. Even if they don’t succeed, you can be sure they will next year — if they hold on to the House in midterm elections.

The growing popularity of key parts of Obamacare is precisely the reason Republicans are highly likely to make a last-ditch effort to kill the ACA.

Here’s what history tells us: Expansions of the social safety net are relatively easy to demonize before they happen — before people get to see what they actually do. Opponents declare that they’ll destroy freedom, that they’ll be wildly expensive, that they’ll be a national disaster.

Once social programs have been in effect for a while, however, and it turns out that they neither turn America into a hellscape nor break the budget, they become part of the fabric of American life, and very hard to reverse.

This has happened again and again. When FDR famously spoke about his opponents and declared, “I welcome their hatred,” he was talking about Republican demonization of the just-passed Social Security Act. But eventually Social Security became effectively untouchable.

And this gets at the heart of conservative opposition to social safety-net programs: It’s not about the belief that they will fail, but about fear that they will succeed, and in so doing become irreversible.

So it has been with Obamacare. Before 2014, when the program went fully into effect, conservatives were quite successful at turning public opinion against it.

But public opinion has shown a steady turnaround since then. The share of voters believing that it’s the government’s responsibility to ensure that all Americans have health coverage has shot up since its 2014 nadir.

When Republicans held town halls over ACA repeal last year, they were shocked by the intensity of public opposition.

Unable to repeal the ACA outright, they’ve tried to sabotage it — using last year’s tax cut to get rid of the requirement that people buy insurance even if they’re currently healthy, using administrative gimmicks to try to undermine the requirement that insurers cover people with pre-existing conditions. But the ACA is proving, from their point of view, annoyingly robust; and most indications are that voters are, rightly, blaming Republicans for rising premiums.

So it’s looking as if Republicans won’t manage to kill health care on the sly. And that means that we can expect one final push at outright repeal — a push that will succeed if Republicans hold the House.