WASHINGTON- Republicans are increasingly worried that their decade-long push to repeal the Affordable Care Act will hurt them in the November elections, as coronavirus cases spike around the country and millions of Americans who have lost jobs during the pandemic lose their health coverage as well.
The issue will come into sharp focus this week, when the White House is expected to file legal briefs asking the Supreme Court to put an end to the program, popularly known as Obamacare. Speaker Nancy Pelosi, seizing on the moment, will unveil a Democratic bill to lower the cost of health care, with a vote scheduled for next week in the House.
Republicans have long said their goal is to “repeal and replace” the Affordable Care Act but have yet to agree on an alternative. This week’s back-to-back developments — Ms. Pelosi’s bill announcement on Wednesday, followed on Thursday by the administration’s legal filing — has put Republicans in a difficult spot, strategists say.
“Politically, it’s pretty dumb to be talking about how we need to repeal Obamacare in the middle of a pandemic,” said Joel White, a Republican strategist who specializes in health policy and has presented legislative proposals to House and Senate Republicans and the White House. “We need quick solutions here; we need stuff that we can do tomorrow, because our countrymen are hurting.”
Health care is consistently near the top of the list of issues voters care about. While Republicans and President Trump tend to have an edge on the economy, Democrats won the House in 2018 in large part by emphasizing health care — a playbook they intend to revive in 2020. The pandemic has also put Republicans at risk of losing the Senate, said Jessica Taylor, who analyzes Senate races for the nonpartisan Cook Political Report.
“There are a lot of factors that have put the Senate into play, but the pandemic and how it has affected health care and the economy is a major one that have made these races competitive,” Ms. Taylor said.
Democrats need to win three Senate seats to take the majority if they also win the White House, four if they do not. Although Cook Political deems one Democratic incumbent, Senator Doug Jones of Alabama, an underdog in his race, it also rates Senate races in five states — North Carolina, Maine, Colorado, Arizona and Montana — as tossups. All have Republican incumbents.
In Montana, Gov. Steve Bullock, a Democrat, jumped into the race to defeat the Republican incumbent, Senator Steve Daines, in March, just as the pandemic was exploding. Three days later, a liberal group, Protect Our Care, announced a $250,000 ad campaign attacking Mr. Daines as “dead set on taking away Montanans’ health care” after voting five times to repeal the health law. Cook Political moved the race to its tossup column last week.
The public has been deeply divided over the Affordable Care Act since it became law in March 2010, according to surveys by the Kaiser Family Foundation. But with people now worried that infection with Covid-19 will become a pre-existing condition, Democrats say the health law — which requires insurers to cover such conditions — is becoming more attractive to voters.
In Iowa, Democrats are running ads attacking Senator Joni Ernst, the incumbent Republican, over her vote to repeal the health law. In Alaska, the Republican incumbent, Senator Dan Sullivan, is facing a tougher-than-expected challenge from a doctor named Al Gross, who is running as an independent but has been embraced by Democrats.
At least one Republican lawmaker — Representative Tom Cole, Republican of Oklahoma and a member of House leadership — conceded that the pandemic has made the electoral terrain for his party more challenging. He said he agreed with Mr. White, the strategist, that now may not be the best time to talk about the repeal.
“Yeah, people are very worried about any kind of change in the middle of a crisis, there’s no question about that,” Mr. Cole said in an interview. “On the other hand, ask Americans: ‘Are you really happy with the health care you’ve got? Do you think it’s reasonably priced?’ and the answer is inevitably no.”
The coronavirus has changed the national discussion around health care in ways that go beyond the issue of cost. The pandemic has exposed racial disparities in care, making health care a more important issue for African-Americans and Latinos, core Democratic constituencies.
And with everyone at risk from a fast-spreading, and sometimes fatal, infectious disease, Democrats have an easier time making the case that everyone should be covered.
“For years, Republicans banked on the idea that people didn’t care about other people’s health care — that you would only care about your own, and their entire campaign against the Affordable Care Act was built on that assumption,” said Jesse Ferguson, a Democratic strategist who specializes in health care messaging.
“People now see a clear and present threat when others don’t have health care,” he said. “Republicans have no response to that because their entire worldview on health care is built on an assumption that’s now out of date.”
And with Mr. Trump making dubious claims about health care — like suggesting people inject or drink bleach, and promoting an unproven malaria drug — Democrats are seeking to paint him and his party as ignorant on an important issue.
“We have become the party of health care — this is increasingly our brand, this is what we have fought for,” said Representative Cheri Bustos, Democrat of Illinois and the chairwoman of the House Democrats’ campaign arm. “They are becoming the party of drinking bleach.”
With more than 120,000 Americans now dead of coronavirus and infections rising in states across the country, Republican strategists say the pandemic has made it imperative for their party to have a health care proposal of its own — both in the short term, to help people who have lost insurance, and the long term.
“It certainly increases the pressure for some sort of minimal health care coverage that everyone can count on,” said Whit Ayres, a Republican pollster.
In a recent survey, Mr. Ayres asked swing-state voters how government should help workers who have recently lost insurance coverage. The poll found that 47 percent supported a major government expansion of health care, 31 percent believed the best option for laid-off workers was to go on Medicaid, and only 16 percent preferred federal subsidies for Affordable Care Act premiums.
Based on that research, and given the Republican inclination to favor a private-sector approach, Mr. White, who is president of a business-oriented coalition called the Council for Affordable Health Coverage, has called for the government to help pay for premiums under COBRA, the program that allows unemployed workers to buy into their former employers’ plan.
“Republicans must offer private market coverage solutions that are preferable to Medicaid (which is now more popular than Obamacare),” Mr. White wrote in a policy memo.
Ms. Pelosi’s bill is aimed at shoring up the Affordable Care Act, which she helped muscle through Congress during her first speakership, and reducing premiums, which are skyrocketing. Ms. Pelosi had intended to unveil the measure in early March, for the health law’s 10th anniversary, at a joint appearance with former President Barack Obama. But the event was canceled amid the mounting coronavirus threat.
The bill would expand subsidies for health care premiums under the Affordable Care Act so families would pay no more than 8.5 percent of their income for health coverage; allow the government to negotiate prices with pharmaceutical companies; provide a path for uninsured pregnant women to be covered by Medicaid for a year after giving birth; and offer incentives to those states that have not expanded Medicaid under the law to do so.
One thing it will not have, aides to Ms. Pelosi say, is a “public option” to create a government-run health insurer, an idea embraced by former Vice President Joseph R. Biden Jr., the presumptive Democratic presidential nominee. The bill being introduced by Ms. Pelosi has no chance of passing the Senate and becoming law, but it will give Democrats another talking point to use against Republicans.
The health law has already survived two court challenges. In the current Supreme Court case, 20 states, led by Texas, argue that when Congress eliminated the so-called individual mandate — the penalty for failing to obtain health insurance — lawmakers rendered the entire law unconstitutional. The Trump administration, though a defendant, supports the challenge.
The justices are expected to hear arguments in the fall, just as the presidential and congressional races are heating up. But Mr. Cole, the Republican congressman, said other issues related to the coronavirus pandemic would also be at play in November.
“If we look like we’re on top of it in September or October and we’re on the way to a vaccine, then it will break to the president’s advantage,” he said. “If we’re in the middle of a second wave, obviously not.”