Why the Democrats’ big push to defend Obamacare is not a slam dunk winner

Democrats face more political risk in opposing repeal of Obamacare than they might think.

Republicans will keep reminding people of the Affordable Care Act’s more unpopular legacies – higher premiums, fewer choices, federal subsidies for coverage – and how they were enacted by Democrats. That effort began Wednesday, as the Senate began debating repeal.

“The failures of Obamacare have metastasized since its passage,” said Senate Budget Committee Chairman Mike Enzi, R-Wyo., as he introduced the measure that will start the repeal process. Republican colleagues then spoke about higher premiums and limited insurance availability, blaming all the woes on the law.

Democrats face another challenge. They need to be careful that in stalling repeal, they don’t appear to be adding to the sort of lawmaking chaos that helped Congress to an abysmal Gallup Poll approval rating of 17 percent last year.

The nation remains split on the health care law’s value. About one-fourth want to see the entire law repealed, while another 17 percent want it scaled back. Thirty percent want the law expanded, while 19 percent want Congress to keep the law as is, according to a Kaiser Family Foundation post-election survey.

Round One of the lengthy health care drama began Wednesday. President Barack Obama visited Democrats on Capitol Hill, while Vice President-elect Mike Pence huddled with Republicans. And the Senate began what promises to be a lengthy debate.

After the Obama session, Senate Minority Leader Chuck Schumer, D-N.Y., met the media and stood in front of a sign warning that repeal would “Make American Sick Again.” Surrounded by two dozen Democratic lawmakers, he predicted that if Republicans repeal the 7-year-old law, they’ll get blamed for every health care problem every consumer faces.

“Republicans have made all kinds of empty promises about how ripping apart the health care system – with no plan to replace it – somehow won’t hurt anyone,” said Sen. Patty Murray, D-Wash.

Democrats said few GOP lawmakers have a sense of how or when to enact alternatives to the law, which requires nearly everyone to have health coverage or pay a penalty.

Pence said after his meeting that there will be an “orderly transition to something better,” but had no specifics. The process “will take several years,” said Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee.

Republicans contend they do have a plan, citing House Speaker Paul Ryan’s “A Better Way” blueprint of last summer. It would allow coverage to be sold across state lines, which proponents say would increase competition and keep prices down. It would also promote individual health savings accounts, which allow people to save tax-free and use the money for health care expenses.

Obama’s aim Wednesday was to remind Democrats that keeping Obamacare alive was not only good policy, but an important part of his legacy as well as theirs.

House Democratic Leader Nancy Pelosi, D-Calif., who was speaker when the law was passed, portrayed the repeal battle as one of dueling political philosophies.

“We have a values debate on our hands,” she said.

But that’s one of several reasons Democrats could find this fight tougher than they’re saying.

If the value in question is quality, affordable health care, then anything that’s gone wrong with anyone’s health care is now blamed on Democrats, Schumer said. As of this month, he said, Republicans would own the health care issue.

Not so fast, said Republicans. They plan to can use the term “Obamacare” over and over to describe any trouble with the system, as they did during the Wednesday Senate debate. They have one big poll number on their side: Kaiser’s survey found only 35 percent of Americans supported requiring nearly everyone to have health insurance or pay a fine.

Republicans blasted the law for double-digit premium increases on many policies. They cite the fate of federal insurance exchanges, marketplaces where consumers can shop for the sort of coverage they need and can best afford.

About one-third of all the nation’s counties will offer only one insurance alternative this year, a huge jump over 2016’s 7 percent. Notably hard hit will be less populated counties in North Carolina, South Carolina and other states with large rural populations.

Democrats have to highlight how repealing Obamacare would end other, more popular provisions, West said. Among them: Barring insurers from denying coverage to people with pre-existing conditions and requiring insurers to keep people under 26 on their parents’ policies, which Kaiser found 85 percent of Americans favor.

President-elect Donald Trump has said he favors keeping those policies, but insurance experts point out that to do so could mean even higher premiums.

Democrats’ other challenge is political. When voting begins on repeal next week, Senate Democrats are expected to offer a large stack of amendments that could lengthen the process. Leaders are talking about marathon voting sessions.

It’s the sort of legislative turmoil that’s kept Congress’ approval rating down for years. Congress’ ratings have been low throughout this decade, “possibly owing to the hyper-partisanship and gridlock” resulting from bitter partisanship as well as other factors, said Art Swift, a Gallup Poll analyst.

Democrats, though, have little choice but to oppose repeal.

“For the Democrat base, opposing repeal is a must. Allowing (the law) to be repealed without a fight to the finish would be more damaging that being seen as obstructing,” said Stan Collender, a veteran budget analyst.

David Lightman: 202-383-6101, @lightmandavid