Obamacare is still law of the land (Paul Ryan's words, not mine), and Democratic Party leaders are more ecstatic than we've seen them in months. Since Nov. 9, Donald Trump and our Republican-dominated Congress have been gleefully candid about their plans to erase Barack Obama’s presidency and all the advances that came with it. No single gain has been subject to as much GOP firepower as the Affordable Care Act, a law that Senate Majority Leader Mitch McConnell promised to repeal as soon as Trump was sworn into office.
All of this has prompted Democratic voters and a number of elected officials to mount something of a grassroots defense campaign for the ACA. From Facebook to Twitter to network TV and the airwaves, Democrats have been busy touting the benefits of Obama’s landmark health care legislation and the grave human costs of repealing the law. Now that the Republicans have lost their first repeal battle, the Democratic Party appears intent on harnessing the grassroots energy to build even more popular support for the ACA. The endgame here is the 2018 midterms, in which the Democrats aspire to flip several tough GOP seats. By preserving the ACA, the Democrats — in theory — stand to be recognized as the saviors of American health care.
It’s one half of a dynamite election strategy. But the second half of that strategy is notably absent from much of the liberal conversation about health care in America. If the Democrats really want to win in 2018, it won’t be enough to protect the ACA. They must offer the American people something better.
This is tough medicine for Democrats, whose partisan instincts perhaps compel them to shield the ACA from all criticisms from conservatives. It’s natural, in any high stakes conflict, to refuse any concession to the other side. But the ACA, while an important step toward true universal health coverage, has not done enough to spare Americans the hardships of navigating — and surviving -- our health care system.
While the ACA provided subsidies for low to moderate-income Americans and cracked open the health care market to previously excluded demographics such as those with preexisting conditions, it has failed to address exorbitant deductibles, drug costs and, as of last year, rising premium prices.
The most irrefutable problem with the ACA is that it still leaves most of the American people at mercy of the for-profit health insurance sector, albeit with some regulatory controls. It wasn’t supposed to be like this. An earlier incarnation of the ACA, championed by Obama and former Senate Majority Leader Harry Reid in 2009, included something that would have alleviated the uniquely American burden of paying for health care: a public option. This key provision was killed by former Democratic Sen. Joe Lieberman, who notoriously threatened to veto any version of the bill that would authorize the creation of “a government-operated-run insurance company.” Defeated from within their ranks, the Democrats gave in to Lieberman’s ransom and removed the public option from the ACA.
Since then, conventional wisdom within Democratic ranks has it that moving beyond the ACA to something that offers universal and affordable coverage is an unfeasible fantasy. Hillary Clinton argued as much during her 2016 presidential campaign, declaring that single-payer health care in America would “never, ever come to pass.” While frustrating to progressive voters, there was a political logic behind Clinton’s refusal to entertain the idea of going beyond the ACA. When Clinton made this statement, the Democrats were expected to win the White House and the Senate. Dreaming and embracing big ideas like universal coverage carries the risk of voter rejection, and this risk was too much for the terminally cautious Clinton to take.
But the 2016 election turned out to be a disaster for Democrats. Today, the party is not just vulnerable, it’s on life support. Thanks to GOP gerrymandering, the midterm races are tilted in favor of incumbent Republicans. The Democratic voter is depressed and split between centrists and leftists. And the Democrats’ ongoing ACA defense strategy offers no hope to the millions of Americans who were struggling to pay for health care long before Trump entered the Oval Office. This does not bode well for a party that aspires to win big in 2018.
The Democrats must learn to dream again. Offering voters something better than the ACA is not only sound strategy, it would be a fitting tribute to President Obama himself, who inspired millions of Americans to imagine a more egalitarian version of America. We all know how that worked out for him. Is the Democratic Party ready to fire up the masses? Liberals can only hope. It’s their best shot at becoming relevant again.