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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Mending Obamacare: Where Do Dems Go from Here?

Now that the Affordable Care Act has been granted a stay of execution, Democrats have a unique opportunity to once again get in front of health care reforms that can win the support of working-class voters of all races. The extremely weak public support for the GOP ‘repeal and replace’ bill (just 17 percent in the recent Pew Research poll) indicates that there is simply no chance whatsoever that the Republicans might provide credible leadership on the issue. Democrats alone have the capacity to build a majority consensus in support of specific reforms needed to strengthen Obamacare, and they should seize the political moment to do so.

Republicans will now try to destroy Obamacare by a thousand cuts, and they do have some worrisome weapons at their disposal, including appropriations and executive orders. They may have some success, but ultimately these battles will be sorted out in the courtroom and the courts of public opinion, where alert Democrats will have the edge. But the challenge here is not so much to react effectively, as to get pro-active and claim ownership of mending Obamacare, while their GOP adversaries continue muck about in their swamp of unproductive ideological excess.

In his Washington Post opinion article, “Democrats should offer solutions, not silence, on health care,” James Downie writes:

Rather than stay on the sidelines, Democrats in Congress should introduce and promote a new health-care plan. The outlines of such a plan are straightforward: expand Medicare and Medicaid, create a public option for everyone else that can use those programs’ pricing power, push regulatory reforms to lower drug prices, and give Medicare the power to negotiate prescription drug prices. Many progressives would prefer a Medicare-for-all system, but this plan would satisfy most of the party, and it has the political advantage of being closely tied to the extremely popular Medicare program.

Those are generally good ideas. but the wisest course may be to not pitch “a new health care plan,” which would be unnecessarily complex, and might cause many time-challenged voters to tune out. Polls now indicate that the public sees Obamacare as a good start, but they believe it needs improvements. Instead of a big, new package, the improvements could be pitched as a series of specific, easily-digestible amendments, one at a time, where possible. That approach has a better chance of securing gradual voter “buy-in,” than does glazing over the eyes of citizens who are still trying to understand the provisions of the ACA. Voters at this political moment don’t want a big honking radical re-do, with lots of bells and whistles; They want credible easy-to-understand reforms, served up in intelligible portions.

Such an approach has the additional virtue of rendering impotent one of the GOP’s most powerful weapons — distraction. By staying on a simple bill, such as an amendment lowering the age for Medicare, or broadening eligibility for Medicaid, or price controls for commonly-used drugs, Democrats can improve the odds that voters will pay attention to the merits of their proposals. Other needed fixes for Obamacare include further reducing the burdens of deductibles and premium costs. As soon as one reform is enacted, Democrats should immediately introduce another.

Republicans have an edge in debates about big package reforms, because they are practiced in distraction. Democrats should not play by their rules. Breaking down needed reforms and presenting them clearly shows respect for health care consumers, and makes it easier for them to identify which elected officials serve their interests, instead of insurance company profits. None of this is intended as a way to head off single-payer or Medicare for all. Rather it is a way to get there, step by achievable step.

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