ACA opposition frays a little further

A sign at an Affordable Care Act outreach event in Los Angeles, California, September 28, 2013.
A sign at an Affordable Care Act outreach event in Los Angeles, California, September 28, 2013.
When Kit Bond was in the Senate, he absolutely hated the Affordable Care Act, and voted to reject and kill the law. As he was getting ready to retire, the Missouri Republican said the impact of the reform law, especially expanding Medicaid, would be "horrific."
Last year, Bond went so far as to describe the Affordable Care Act as "a pile of manure."
Now, however, it appears Bond, a former two-term governor and four-term senator, has changed his mind, at least about one key aspect of the law.

Proponents of expanding Medicaid in Missouri just landed an influential -- and unlikely -- new ally. Republican and former U.S. Sen. Kit Bond has been hired as a lobbyist by the Missouri Chamber of Commerce and Industry. His goal will be to persuade a General Assembly skeptical of all things Obamacare to go along with one of the law's central tenets -- adding 300,000 uninsured Missourians to the public health insurance program for the poor.

Dan Mehan, the Missouri chamber's president, told the Kansas City Star that the business lobbying group "opposed Obamacare," but the organization believes it will remain the law of the land. And as such, Mehan added, "We should take the opportunity to get an enormous amount of investment back into our state and, while we're at it, improve Medicaid for everyone."
It's not clear exactly when Bond got on board with the idea, but state Republican lawmakers in Missouri report that they've already heard from the former senator, who urged them to accept Medicaid expansion.
And why did he change his mind? Bond told the Associated Press, "While I was and still am one of the loudest opponents of Obamacare, I'm getting involved in Medicaid reform now because if our state sits on the sidelines, I'm concerned hospitals in rural and inner city Missouri won't survive."
To be sure, that's a perfectly good reason to support a perfectly sensible policy. But Bond's 180-degree reversal reinforces a larger truth about the nature of ACA opposition: it's fracturing in ways that spell trouble for conservatives.
Indeed, the senator's comments to the AP are important in that they expose opposition to the law as a bit of a sham. Bond is proud to be a "loud opponent of Obamacare," but he also believes the dastardly law is important to securing health care systems in rural and inner city Missouri. So the ACA is a good deal for Bond's state, even though he voted against it, and even though he opposes the law for reasons that are unclear.
And it's not just Missouri. Dylan Scott had a good report this morning on West Virginia, where Rep. Shelley Moore Capito (R), a leading U.S. Senate candidate, has voted to repeal the law, but is now comfortable leaving Medicaid expansion in place.

The conventional wisdom is that Republicans running in 2014 will be campaigning against Obamacare, attempting to recreate the 2010 magic that saw them make massive gains in Congress and state governments, holding themselves in stark contrast to Democrats who are responsible for what the GOP sees as a fatally flawed law. That's the narrative, and that's what Republican strategists would have you believe. But comments -- or the lack thereof -- from some GOP candidates in state and national elections suggest that opposition might not be as ironclad as previously believed, as the Washington Post's Greg Sargent has documented. In at least one case, in fact, a Republican in one of the most competitive Senate races in the country effectively endorsed the expansion. It's a huge shift from the "defund or repeal" mantra during the government shutdown of October, a possible indicator that some conservatives are recognizing that Obamacare is here to stay -- and that proposing to knock the newly enrolled off Medicaid is politically perilous.

What's more, as we discussed on Friday, Utah's Republican governor just endorsed Medicaid expansion in his state, and Republicans in Michigan and Iowa are considering following suit.
For the last few years, the full repeal of the Affordable Care Act has been a staple of Republican rhetoric, but it's becoming increasingly obvious that the GOP's posture is evolving. At this point, the Republican position appears to be, "We hate Obamacare with every fiber of our being, except for the parts about Medicaid expansion, covering pre-existing conditions, making it easier for seniors to pay for prescription medication, tax breaks for small businesses, allowing young adults to stay on their family plans until their 26th birthday...."
This isn't a sustainable approach to health care policy. Republicans have voted dozens of times to repeal the law, but they still have no alternative, and a growing contingent within the party now endorses one of the key provisions that expands coverage for struggling families.
The ACA opposition, in other words, is fraying, which is generally a precursor to defeat.