The GOP has made opposition to ObamaCare a central pillar of its 2014 campaign strategy. And even though the health care law has begun to turn around, that may not be such a bad idea given lingering public skepticism over the law.
However, there is one crucial piece of ObamaCare that may well become a big winner for Democrats by the end of the year: The dramatic expansion of Medicaid.
Unlike the overall law, the expansion of Medicaid is actually quite popular with voters of all political stripes. Even in the Deep South, more than six in ten support expanding Medicaid, according to one survey last year; conservatives split almost evenly on the issue.
This presents the GOP with two interconnected problems.
First, it undermines part of the party's "repeal" crusade, since nixing ObamaCare would mean ending a popular policy that has already extended benefits to millions of Americans, many of them previously uninsured.
In red West Virginia, some 75,000 people have already enrolled in Medicaid, far higher than expected, according to The New York Times. As a result, the number of uninsured people in the state has plummeted by about a third.
From the Times:
Waitresses, fast food workers, security guards, and cleaners described feeling intense relief that they are now protected from the punishing medical bills that have punched holes in their family budgets. They spoke in interviews of reclaiming the dignity they had lost over years of being turned away from doctors' offices because they did not have insurance. [New York Times]
That's a perfect 2014 Democratic ad campaign right there: People are happy now that they're covered by Medicaid, and Republicans want to take it away.
Though voters are generally leery of ObamaCare as a whole, they like the Medicaid expansion because they support the idea of extending coverage to the needy. As the Washington Post's Greg Sargent notes, this gives Democratic candidates in red states some wiggle room.
They are not embracing ObamaCare. But they oppose repeal, and they are standing behind the general goal of expanding coverage to those who can't afford it. This is true of Michelle Nunn in Georgia (where 57 percent support the Medicaid expansion) and Alison Lundergan Grimes in Kentucky, who wants the law fixed and supports making coverage available to hundreds of thousands of Kentuckians, rather than throwing "the baby out with the bathwater."
None of these Dems were in Congress to vote for ObamaCare, so they are free not to embrace the law overall while supporting a part that's providing more and more coverage and security to people who lacked it. [Washington Post]
On another level, the GOP may have shot itself in the foot by broadly opposing Medicaid expansion at the state level from the get-go.
Thanks to a Supreme Court ruling, states are able to opt out of the Medicaid expansion. So even though the federal government will cover 100 percent of the added costs for the next three years, and 90 percent of the costs after that, 24 mostly GOP-controlled states have decided not to participate.
Virginia, under then-Gov. Bob McDonnell (R), is one of the states that opted out. However, McDonnell's would-be GOP successor, Ken Cuccinelli, lost last November's gubernatorial election after vowing to continue that policy. While Cuccinelli was a uniquely terrible candidate who lost for a host of reasons, it's likely that his position on Medicaid played a role, too. A recent Roanoke poll of Virginia voters shows that only one-quarter think Medicaid should not be expanded.
The refusal of some states to expand Medicaid has left an estimated eight million people with no access to affordable health care, all of whom would otherwise have been eligible under the program. Republicans have almost gone out of their way in fulfilling the Democrats' caricature of the GOP as a heartless "party of no."
Perhaps it's no surprise, then, that several GOP-led states are already beginning to reconsider accepting the expansion after all.
If Republicans continue to staunchly oppose the Medicaid expansion on principle, they'll be rejecting a widely popular policy and effectively advocating to push people off their new health care coverage. As we saw last year with Obama's broken "you can keep it" promise, stripping people of their existing health insurance doesn't go over so well.