CONCORD, N.H. — Scott Brown launched his national career four years ago with a pledge to block President’s Obama’s health care plan. But now, even as he campaigns for the US Senate in New Hampshire on what he called the “Obamacare Isn’t Working” tour, he is showing an openness to keeping some of the extolled benefits of the overhaul.
That includes an expansion of health insurance for low-income residents using Medicaid money, recently approved by New Hampshire’s Legislature.
“You can incorporate any of the considerations for those people on Medicaid expansion into a plan that works for us,” Brown said Wednesday in Concord, after touring a company that designs, manufactures, and sells medical electronics.
Brown, hoping to capitalize on the particularly rocky rollout of the overhaul in New Hampshire, favors repealing the overall law and said he cast three votes to do so while he served in the Senate representing Massachusetts.
But he did not directly answer questions from a reporter about whether he supported or opposed the Medicaid expansion. Instead, he expressed concern about the Obama administration’s “trail of broken promises” and said he wondered where money for expanded coverage would come from after three years, when the federal government’s commitment drops from 100 to 95 percent of the cost.
Brown’s conundrum is emblematic of a tension facing Republicans around the country. The health law’s low standing in opinion polls is a key reason many political handicappers are predicting that Republicans will regain control of the Senate after this November’s congressional elections.
But Democrats are hoping to at least mitigate some of that damage, and possibly even win advantage, by forcing Republican critics to take positions on the law’s more popular provisions, including the Medicaid coverage expansion that was made optional in a Supreme Court ruling.
The issue has divided Republicans. The party’s governors in Arizona, Nevada, Ohio, Iowa, New Mexico, North Dakota, New Jersey, and Michigan are among those who have agreed to some form of Medicaid expansion.
Despite that, some Democrats in tough elections have been reluctant to talk about the issue because they do not want to highlight the health care law in states where Obama lost during the 2012 election. One exception, Senator Mary Landrieu has been the most aggressive in challenging Republicans in Louisiana to expand Medicaid, making their resistance a campaign issue.
Still, Republicans say they believe that the health law remains a distinct political advantage for their party.
“You can pick out parts of it that you think are fine, but the overall impression on the part of the Republicans and independents is that they do not approve,” Senator John McCain said in an interview. The Arizona Republican represents a state in which Governor Jan Brewer approved Medicaid expansion.
The focus on the Affordable Care Act in New Hampshire, a state which Obama carried in 2012, is being closely watched across the country. New Hampshire, which holds the nation’s first presidential primary, is “purple,” not predictably Republican or Democrat, and is seen as a preview of broader battles in the midterm elections and the 2016 White House race. Its voters are a mix of free-market conservatives, traditional liberals, and independent-minded voters who often upend conventional political wisdom.
Republicans, meanwhile, hope Senator Jeanne Shaheen, the Democratic incumbent who has been on defensive over her support for the health law, will pay the biggest price in the health care debate. She initially repeated Obama’s inaccurate pledge that people who liked their insurance could keep it and later filed a bill to preserve coverage for those who saw their plans canceled.
In an interview, Shaheen said she was also working with fellow senators to address “a number of concerns from small businesses,” including the requirement that employers subsidize insurance to full-time employees. But she would not detail any proposals, nor would she say what other issues she believes need fixing.
“We will see as the law is implemented that there will be other things that come up,” she said.
Shaheen said she is “absolutely” proud of her vote in favor of the bill and said residents frequently tell her how much the law has already helped them. But it is unclear how much she will campaign on the issue. For example, she declined to say whether she would hold an event to highlight the law’s benefits, as Representative Carol Shea-Porter, another New Hampshire Democrat in a tough election, did earlier this week.
Brown declared his candidacy last month, two weeks after the state became the 26th to agree to use Medicaid money to expand health coverage, with bipartisan support in the Legislature.
On his campaign website, Brown says little about an alternative health care plan, saying he wants state control. During a recent interview with WMUR-TV in New Hampshire, Brown suggested that the state plan could be similar to Obama’s plan, including expanding Medicaid.
“In terms of preexisting conditions, catastrophic coverages, covering kids — whatever we want to do, we can do it,” he said, referring to provisions in the law that forbid insurers from denying coverage to sick people and that allow children to remain on their parents’ plan until they are 26. The plan “can include the Medicaid expansion for folks who need that care and coverage,” he added.
Brown called the health law the state’s number one issue, warning that taxes and mandates for businesses were set to increase and that seniors who opt for Medicare Advantage, a managed-care version of Medicare, would see spending on that program cut drastically. He has also noted that the only insurance plan currently offered on the state’s insurance exchange excludes many hospitals and providers, forcing patients to drive more than an hour for care.
Critics said neither the federal nor the state governments could afford all the options and improvements mentioned by Brown without increasing taxes or expanding the deficit, both of which Brown opposes.
“There is no bill that does that,” said John McDonough, a Harvard public health professor who advised the Senate when it crafted the health law. “There is no way to achieve the popular without embracing some unpopular positions.”
Brown’s comments also have drawn criticism from Shaheen and his opponents in the Republican primary.
“I’m sure the people of New Hampshire will be able to see through the fact that he voted for Romneycare in Massachusetts, that he comes on WMUR and says ‘I think we should support all the provisions that are popular but I want to repeal the law’ and he’s got no plan to replace it with,” Shaheen said in an interview in the Senate this week. “People can read through that pretty clearly.”
Brown’s Republican primary rivals have called his answers vague and also point to his vote as a state senator in favor of Romney’s plan to question his conservative credentials. Brown won a special US Senate election in Massachusetts in 2010, pledging to block Obama’s plan for a national health law, but Democrats crafted a legislative maneuver that allowed them to pass the law without him. He lost his seat in 2012 to Senator Elizabeth Warren, a Democrat.
“I fail to see a distinction between Romneycare’s mandate that everyone purchase health insurance and Obamacare’s mandate that everyone purchase insurance,” said former New Hampshire state senator Jim Rubens, one of Brown’s GOP opponents.