Riling those voters is especially unwise for a party that does best when voter turnout is low. In off-year elections, when participation drops below 40 percent, Republicans dominate. As voter numbers rise, Republicans find it harder to compete. In 2004, when 122 million voted, George W. Bush squeaked through with 50.73 percent of the vote. But in 2008, with 131.5 million coming out, Republicans were smoked, and they were beaten only a little less badly in 2012, with 129 million votes cast.
The best Republican hope for 2016 is that Hillary Clinton will prove another John Kerry: A dull, uninspiring candidate who won’t summon the disaffected younger, poorer, minority voters who queued to cast a ballot for Barack Obama. But if there is any one thing most likely to mobilize those voters, it is a direct attack on their healthcare coverage. Those Republicans who urge the party to define 2016 as another “time for choosing” forget that when Ronald Reagan issued that call in 1964, the voters chose Lyndon Johnson and Medicare. Those who insist that Obamacare is “all or nothing” overlook the high likelihood that the outcome in that case will be “nothing."
What should Republicans do instead?
Republicans should accept the Affordable Care Act as a permanent new fact of American society. They should accept universal healthcare coverage as a welcome aspect of any advanced democracy. Instead of fruitlessly seeking to repeal a law now that will in 2016 enter into its fourth year of operation, they should specify the law’s most obnoxious flaws and seek a mandate to reform them.
My list would start here:
1) Fix the funding mechanism. The ACA purports to finance itself with two highly redistributive taxes, one on upper incomes, another on dividend income. These eye-catching taxes distract attention from the real working engine of the law, the internal redistribution within the insurance pools from young and healthy to middle-aged and less healthy. That internal redistribution renders ACA plans an unattractive proposition for the young and healthy. Meanwhile the people receiving the most benefit are 55-65 year olds who may or may not need it—those older cohorts after all are considerably more affluent than the young.
ACA funding should be visible and broadly based. Universal health coverage benefits everybody; all should contribute toward its costs. I’ve long been attracted to directing the proceeds of a carbon tax to health coverage. The taxes on upper-income earners in the ACA was a political maneuver to round up Democratic votes in Congress after hopes of bipartisan agreement faded. One-party backing for a major social program is not sustainable over the long haul.
2) Let states run their Medicaid programs their way. About half the people who gained coverage under the ACA did so through Medicaid expansion. Yet 19 states have refused to expand their programs, under the leeway allowed by the Supreme Court in the first challenge to Obamacare, back in 2012. Under the ACA, the federal government covers all the costs of Medicaid expansion through the end of 2016. The federal share of the extra costs then declines to 90 percent by 2020. Thereafter, the states face a very real likelihood of an ever-rising share of the added costs. Yet even as the federal contribution shrinks, the ACA’s burdensome new Medicaid rules would remain in place. You can see why states would protest.