Opinion

SCOT LEHIGH

The tricky politics of Obamacare

I’m admittedly looking for the silver lining in a midterm cloud here, but there’s some evidence that the public is coming around on the Affordable Care Act.

Not so long ago, the Republican-controlled House was taking symbolic votes to repeal Obamacare every half hour or so, while conservatives were predicting that Obamacare would sink Democrats this fall.

But the public mood has changed, at least somewhat.

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Mind you, the Democrats still have enough problems that they may lose control of the Senate. Still, voters overall seem less hostile to the ACA.

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Some evidence comes in a recent George Washington University Battleground poll, conducted by pollsters Celinda Lake, a Democrat, and Ed Goeas, a Republican. To be sure, that nationwide survey of 1,000 likely voters revealed deep pessimism, with 58 percent feeling strongly that the country is on the wrong track, and another 12 percent partly in agreement. The top reasons: dislike or disapproval of the president (19 percent), worries about the world and US foreign policy (12 percent), concerns about Congress (11 percent), and anxiety about the economy (9 percent). Obamacare? Just 5 percent.

By 46 to 42 percent, voters said they were inclined to vote Republican in House races. Why? Well, 24 percent said the economy, 17 percent said a variety of reasons, and 15 percent cited feelings about their representative. Obamacare came in fourth, at 13 percent.

That stops well short of a tidal wave.

“I think that, short of something else emerging in the fall, it is diminished in its power,” says Lake.

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What’s more, Republicans have moved away from their tight focus on the issue and, by and large, are not making it a central part of their advertising attacks on Democrats, says Peter Hart, the Democratic half of the bipartisan duo that polls for NBC News and the Wall Street Journal. That hardly means Democrats are out running “I told you so” ads, Hart notes. Opinions haven’t changed that much. Still, the ACA “is no longer the hot button that it was,” the pollster says. “The furor about what the Affordable Care Act would do to our society is giving way to the recognition that it hasn’t changed our lives dramatically.”

Not so fast, retorts GOP pollster Whit Ayres: The ACA is still a hot issue where it really matters this year, which is in the dozen states with tight Senate races.

“The health care law is one of the top issues for Republicans and independents, and trust me, they are not in support,” says Ayres, who with Democratic pollster Stan Greenberg has just completed a survey for National Public Radio of those states. Among all voters in those states, the economy, at 55 percent, is the biggest issue driving voters, with the ACA next, at 36 percent, followed by foreign policy and the Islamic State, at 33 percent, he says.

Point noted. And yet, when you delve into other polls, a couple things jump out: Despite their doubts about the law, by significant margins, Americans would rather see it improved than repealed.

Second, as has long been the case, there’s strong support for most of the ACA’s major provisions, other than the individual mandate, which requires individuals to purchase insurance if they aren’t otherwise covered.

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Here’s where good policy and good politics collide: In a health care system built on private insurance, it’s almost impossible to guarantee that people can buy affordable insurance despite pre-existing conditions without also mandating that everyone carry coverage. Without that requirement, some would wait until they become ill before buying coverage, which of course undermines the notion of insurance.

By significant margins, Americans would rather see it improved than repealed.

The popularity of much of the law has left some Republicans doing some serious pretending or temporizing.

Senate Minority Leader Mitch McConnell, for example, has suggested Kentucky could keep its health care exchange, kynect, even if the ACA is repealed. (Um, what about the federal subsidies that many need to make insurance affordable?)

In New Hampshire, Scott Brown, who initially suggested Obamacare could be repealed with New Hampshire beneficiaries somehow grandfathered into the eliminated law, now talks vaguely about replacing the ACA with a state plan.

Republicans playing those games are obviously hoping they can sidestep the true choices or lose voters in the details.

And perhaps they can.

Yet if Democrats pointed out the incongruities or the emptiness of those stands, they just might find an interested audience.

Scot Lehigh can be reached at lehigh@globe.com. Follow him on Twitter at @GlobeScotLehigh.