This weekend I did what no sensible human being should do, which is stay up late on a Saturday evening watching the House of Representatives debate the Affordable Care Act on CSPAN. After the back and forth, the parliamentary equivalents of “you got served, Mr. Speaker” and callers decrying the state of the nation, the house voted for a continuing resolution (CR) to fund the federal government. Without such a bill, we’re slated for a shutdown beginning tomorrow (not to mention a looming debt ceiling in the second-half of October). Saturday night’s vote makes that possibility much more certain.
Why? Because the bill passed by the House includes a one-year delay of the ACA’s major provisions; including the individual mandate, taxes, and of course benefits. It also contained a repeal of the law’s medical device tax, as well as a so-called “consciousness clause” related to employers and contraception. This will be unacceptable for the Senate, which earlier had passed a “clean” CR that included funding for the ACA. The bill would also be vetoed by the president, though it most certainly would not get to that point, for political and other reasons.
Republicans last night framed this as a compromise because their original legislation set out to defund the health care law. This new one ‘only’ delays it. Though amusingly one House Republican last night framed this as an opportunity to fix the law, having previously voted 40 plus time to repeal it casts doubt on that reasoning. This position fits within a broader conceptual framework for why such moves are not equivalent. Last night’s vote also fits into a deeper discussion going on vis a vie the internal dynamics of House Republicans, which I won’t go into here. There is also an argument that a government shutdown in this environment could be construed as good news, and compared to a counter-factual of a debt default, sure. Yet that’s an incredibly low bar. Suffice it to write that despite passing legislation that will one-hundred percent not become law and most likely result in a government shutdown, as one noted Representative from Minnesota exclaimed, “It’s a fabulous bill!”
It’s also represents a legislative effort that, according to a Morning Consult poll, is incredibly unpopular (from page 12 of the topline results):
When Texas Senator Ted Cruz spent over 20 hours speaking on the Senate floor, his appeal to legitimacy was founded on Americans objecting to the ACA. Apparently he wasn’t privy to this feedback from the people. As you can see only six percent of registered voters responding to this poll said Congress should defund or delay the ACA. This illustrates why it’s important for organizations doing this work to go beyond asking whether folks have a favorable or unfavorable view of the law. Some portion of the 42 percent who believe that Congress should fix or expand the ACA could in fact view the status quo unfavorably. Nevertheless, though this may break down further along partisan lines even Republicans are opposed to delaying and defunding; only six percent support this strategy.
Of course this isn’t a new phenomenon. Polling from the Kaiser Family Foundation (KFF) found as late as March of last year that most Americans wanted to keep the ACA or expand it. In May poll respondents overwhelming rejected the conservative position towards the ACA. There is some nuance here, though. Those polled, both from the Consult Group and KFF, also show mixed feelings towards certain aspects of the law—unsurprisingly, they don’t care for the mandates or taxes. They are also uniformly skeptical that the law will help them personally, or make health care in general more affordable in the future.
Yet contra many pundits, it isn’t amazing that consistent negative attitudes exist alongside a universal refusal to support elected Republican efforts. What is amazing is that those opinions exist alongside an astounding level of ignorance about the law. In the new KFF tracking poll 64 percent of the public, including 74 percent (!) of those who were uninsured, didn’t know that enrollment on the exchanges start tomorrow. More than 40 percent of the public had no knowledge of the exchanges at all, nor on the existence of subsidies, the Medicaid expansion, or guaranteed issue. Over half incorrectly believe that the law established a public option. Over 40 percent erroneously ‘know’ that the law gives undocumented immigrants money to buy insurance. That same amount, moreover, believe that “death panels” are real and that Medicare benefits will be cut—both things that absolutely are not in the law. I can include that, at least anecdotally, some still think people will go to jail if they do not comply with the individual mandate.
There are, consequently, some interesting questions that emerge from knowing that large pluralities consistently don’t know about the benefits of the ACA and falsely understand there to be components that don’t exist. First, if this represents the contemporary public attitude then how will it shift as they inevitably understand it better? Perhaps, as Republicans fear, the public’s favorability will increase. Overwrought rhetoric describes this as a path towards dependency, but a more mundane observation would be that people will find that the law benefits them or folks they know. Second, what does this say about Republicans who claim they represent the people’s will? They don’t. Much of the public is ignorant about the law and they still don’t support the GOP attempts to derail it.
I’m struggling to construct the right words here to accurately describe why conservatives are willing to shut down the government in order to repeal, defund, or delay the law. It isn’t what the public appears to support, of course, but more importantly any of the three would effectively deny millions of low-income and sick Americans access to health insurance. There is a not-insignificant part of the GOP in the House that seemingly cannot acknowledge this consequence. For too many of them it is still a bill, not a duly-enacted law that survived a Supreme Court decision and a national election. They can’t even vote their preferred alternative out of committee. This endeavor by a segment of one-half of one-third of the government to stop the implementation of the ACA can be summed up in a basic sentence; to “[m]ake sure that the working poor don’t have access to affordable health care.”