When Sen. Ted Cruz timed his presidential announcement earlier this week to the fifth anniversary of the Affordable Care Act, his fondest hope was that the law would not survive for many more. "Imagine in 2017," Cruz declared, "a new president signing legislation repealing every word of Obamacare."
Sen. Ted Cruz speaks during the "Exempt America from Obamacare" rally, on Capitol Hill, September 10, 2013 in Washington, D.C. (Drew Angerer / Getty Images)The determination among conservatives to uproot the ACA is strikingly undiminished five years after President Obama signed it into law. But the context for their crusade is shifting. Defying opponents' predictions, and its own early stumbles, the law is now contributing to a virtuous cycle generating gains in coverage, cost, and quality across the health care system. The critical question for the future may be whether those positive trends build enough of a constituency to protect the law by 2017, when Republicans could win the unified control of the White House and Congress they will need to undo it.
The war over the ACA has already outlasted the skirmishing that followed passage of America's other key safety-net programs. In 1936, Republican presidential nominee Alf Landon ran on repealing the Social Security Act, signed one year earlier. But after Landon won just two states, Wendell Willkie, the 1940 GOP nominee, embraced the program. Neither congressional Republicans nor Richard Nixon, the party's 1968 presidential nominee, sought to repeal Medicare after Lyndon Johnson signed it in 1965. And while some states initially resisted joining Medicaid, that opposition melted quickly.