The Senate began the process of dismantling Obamacare early Thursday morning, passing a budget blueprint that sets the stage for a formal repeal vote, potentially within a few weeks.
The step is, for now, procedural, but it signals Republican lawmakers are following through on their longstanding promises to axe the law.
In his press conference this week, President-elect Donald Trump assured Americans once again that Obamacare will be repealed and replaced, “essentially, simultaneously.”
The pesky details are still TBD, as he explained: “It will be various segments, you understand, but will most likely be on the same day or the same week, but probably, the same day, could be the same hour.”
But the implication is clear: “So we’re gonna do repeal and replace, very complicated stuff,” he said, repeating one of his favorite lines: “Obamacare is a complete and total disaster.”
This, for some, raises the question: How much of the Obamacare-antipathy is about its namesake? Obamacare certainly has its warts, but Republicans have not coalesced around a replacement plan that would insure as many people while offering them the same choices and costing less. Would a health-care law by any other name be such a political lightning rod?
Obama’s opponents were already calling the Affordable Care Act “Obamacare” in 2011, when Obama himself reclaimed the moniker. “They call it ObamaCare?” he said, as the Hill reported at the time. “I have no problem with people saying Obama cares. I do care.”
This was after some of the law’s more popular provisions—like allowing people to stay on their parents’ insurance plans until they’re 26—snapped into place, but before the rollout of the more controversial individual mandate and cantankerous website.
At the time, Obama tried to frame it as though only the truly heartless could be against something ending in -care. “If the other side wants to be the folks that don’t care,” he said, “that’s fine with me.”
Of course later, when the Obamacare plans became too expensive for some people, “care” is not the part of the name Obama’s opponents seized on. After a few years of rate hikes and narrow networks, a slight majority of Americans disapprove of the Affordable Care Act, and it has become easier for Republicans to advocate for repealing it by associating it with the failures of a liberal, departing president. Trump almost exclusively calls it Obamacare, and Republicans often frame repeal as “relief from Obamacare.”
Still, the majority of people who are actually on Obamacare plans or Medicaid are satisfied with their coverage, according to the Commonwealth Fund, and only 20 percent of survey respondents told the Kaiser Family Foundation they want the law repealed before the details of a replacement are made clear. In other words, the people who benefit from Obamacare are happy with it, and Americans’ zeal for wantonly scrapping the law, if it ever was fervent, seems to have dampened.
All of this makes it tempting to think Obamacare would not be on the ropes if it had been called literally anything else. Like KFC and Healthy Choice, maybe all it needs is a good, old-fashioned face lift. A bold new look, same great taste.
“Obamacare does not have a policy problem,” argued The Washington Post’s Catherine Rampell recently. “It has a branding problem.”
Is that really all it is?
Some people who dislike Obama might allow their disdain to permeate everything he’s done—including laws that objectively help them. This helps explain why conservative Medicaid recipients in Indiana told The New York Times they want Obamacare gone, even though the law paid for their cancer treatment. Or why some Pennsylvanians told me they want subsidies for health insurance, just not Obamacare subsidies. Indeed, some surveys suggest people view the law more favorably when Obama’s name isn’t mentioned.
It’s a kind of reverse “halo effect,” says Scott Rick, an associate professor of marketing at the University of Michigan. “If you already like someone, anything new they do gets the benefit of the doubt. If you already dislike someone, everything they subsequently touch is tainted. For many conservatives, Obamacare is the fruit of a poisonous tree.”
Some states have found the label so toxic that, in an effort to boost enrollment, they hid it. Kentucky expanded Medicaid under Obamacare, but the state called it “Kentucky Connect” (portmanteau’d to “Kynect”) because, as Obama told Vox recently, “I don’t poll that well in Kentucky.”
But not all Obamacare hate is misplaced Obama hate. “I believe there is certainly many individual cases where maybe the law’s unintended consequences of narrower networks and higher deductibles was a factor in their displeasure,” said G. William Hoagland, a senior vice president with the Bipartisan Policy Center and former staffer for Republican senators. “And the initial roll-out suggested for many that government could not handle such a major change in policy.”
And Obama-related Obamacare-hate is not necessarily misplaced, either. Even Obamacare supporters had their faith shaken by Obama’s broken promises about keeping existing plans, premiums declining by $2,500, and the disastrous website roll-out.
Hoagland believes a less-controversial name wouldn’t have spared the law peoples’ wrath. And a more anodyne nickname—say, “Faircare”—might not have stuck as firmly as Obamacare did.
“It already had just about the most innocuous name possible: the Affordable Care Act,” Rick said. “That name, in and of itself, is insightful branding.”
“Unfortunately,” he added, “Obamacare is even better branding.”
Obamacare—with its pleasant pattern of long and short vowels and its echo of better-liked Medicare —is, for better or worse, easy to remember, said John E. McDonough, a Harvard professor who worked on the Affordable Care Act. “Easier even than Affordable Care Act—which I, to this day, hear people mangle (i.e.: Accountable Care Act, Affordable Coverage Act, etc.),” he added.
It’s conceivable Obamacare could have saved itself from its name by working better. If people weren’t so dissatisfied with their networks and deductibles, perhaps they would have embraced Obamacare—and, in turn, Hillary Clinton, who promised to build on it, rather than destroy it. But even McDonough doubts that would have prevented “Obamacare” from catching on, and, eventually, being contaminated.
“It feels similar to ‘Hillary-care’ in the early 1990s—once it was out there, it was almost impossible to shake,” he said. In embracing the label, the Obama administration was wrong to think people would like their new plans enough to override the relentless criticism of the law, he added.
Perhaps Obamacare, and Hillarycare before it, is a cautionary tale for what some are now recommending: Simply tweaking Obamacare slightly and renaming it “Trumpcare.” Health insurance and politicians are two of the country’s least-lovable entities—it’s probably not wise to combine the two. Medicare was not called Johnsoncare, after all. And Romneycare, Massachusetts’s state-based Obamacare predecessor, did pose a bit of a problem when its eponymous governor ran for president in 2012, but it was eclipsed by bigger issues.
Rick, the branding expert, thinks perhaps the Republicans should name their replacement bill something that will resonate better with conservatives. “Adding ‘freedom,’ ‘liberty,’ or ‘responsible’ to the title might help,” he said. “Maybe the ‘Responsible Coverage Act.’ I say ‘coverage’ instead of ‘care’ because for some conservatives, ‘care’ may sound too feminine.”
But, you know, you’re going to want to focus-group that “Freedom Coverage” first.