The government benefits began their existence as objects of partisan rancor and harsh criticism. Eventually, though, they became so popular that politicians of both parties promised to protect them.
It was true of Social Security and Medicare. And now the pattern seems to be repeating itself with Obamacare.
Consider what has happened recently in North Carolina: Only a decade after the state’s Republican politicians described the law as dangerous and refused to sign up for its expansion of Medicaid, Republicans and Democrats came together to pass such an expansion. The Republican-controlled House in North Carolina passed the bill 87 to 24, while the Republican-controlled Senate passed it 44 to 2.
“Wow, have things changed,” Jonathan Cohn wrote in a HuffPost piece explaining how the turnabout happened.
Obamacare — the country’s largest expansion of health insurance since Medicare and Medicaid in 1965 — is still not as widely accepted as those programs. North Carolina became the 40th state to agree to expand Medicaid under Obamacare, which means that 10 states still have not, including two of the largest, Texas and Florida. In those states, more than 3.5 million adults lack health insurance as a result.
But the list of states signing up for the program seems to be moving in only one direction: It keeps growing.
In its growing acceptance, Obamacare resembles other major parts of the federal safety net:
When Congress was considering Social Security in 1935, conservatives and many business executives bitterly criticized it. One Texas newspaper described Social Security as “a huge sales tax on everybody on behalf of the oldsters.” A Wall Street Journal editorial predicted that the law would eventually be reason for Congress to look back in “humiliation.” Not exactly: Social Security is so popular that it is known as a third rail in American politics.
When Congress was debating Medicare in the 1960s, Ronald Reagan — then an actor with a rising political profile — attacked the program as a step toward socialism. If it passed, Reagan warned, “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.” As president, Reagan praised and supported the program.
After Congress created Medicaid — a health-insurance program primarily for low-income households — in 1965, some states did not initially join it. Arizona became the last to do so, in 1982.
Roberts and McCain
In the initial years after Obamacare’s passage in 2010, it was similarly divisive. Blue states embraced it, while many red states rejected its voluntary Medicaid expansion. In Washington, congressional Republicans and Donald Trump tried to repeal it. Some Republican-appointed judges invalidated parts of it, and every Republican appointee on the Supreme Court except Chief Justice John Roberts voted to scrap the law.
Twice, it survived by a single vote — first, by Roberts’s 2012 Supreme Court vote, and then by Senator John McCain’s late-night vote against its repeal in 2017. Since then, however, Obamacare has been gaining Republican support.
The next year, voters in Idaho, Nebraska and Utah — red states, all — passed ballot initiatives expanding Medicaid. Oklahoma, Missouri and South Dakota have since done so. Montana’s state legislature has also approved an expansion.
In 2019, Gov. Andy Beshear of Kentucky, a Democrat, narrowly won election in a Republican state by pledging to protect an earlier Medicaid expansion. In North Carolina, Roy Cooper, also a Democrat, became governor in a 2016 upset partly by campaigning in favor of an expansion — and was able to sign one this week.
(Before it takes effect, Cooper and the legislature must agree on a state budget.)
These developments are a sign of the law’s growing popularity. And that popularity isn’t especially mysterious: In a country with high levels of economic inequality and large numbers of people without health insurance, Obamacare has increased taxes on the affluent to subsidize health care for poor and middle-class families. At root, it is an effort to reduce inequality.
Winning the middle
Even with its flaws — including its often complicated process for signing up for insurance — the law has achieved many of its aims. The number of Americans without health insurance has plummeted. In states that have refused the Medicaid expansion, by contrast, rural hospitals are struggling even more than elsewhere because they do not receive the law’s subsidies for care.
Greenwood Leflore Hospital — in the Mississippi Delta — is an example. It recently closed its intensive-care unit and maternity ward, as our colleague Sharon LaFraniere has reported. Nationwide, states that did not quickly accept Medicaid expansion have accounted for almost three-quarters of rural hospital closures between 2010 and 2021, according to the American Hospital Association.
Similar problems in North Carolina were a reason that Republicans there reconsidered their opposition to Medicaid expansion. “We had these people coming down to Raleigh, farmers, business owners, people from rural areas, they were advocating, telling stories,” one Republican state representative told HuffPost.
Many Republicans still oppose Obamacare, and some hard-right members of Congress also favor cuts to Medicaid — as well as to Medicare and Social Security. In a country as polarized as the United States, there isn’t much true political consensus. But Obamacare has won over the political middle more quickly than seemed likely not so long ago.
Related: The number of people signing up for insurance through Obamacare has surged over the past two years, partly because of a new subsidies signed by President Biden.
THE LATEST NEWS
Mike Pence must testify to the grand jury investigating Trump’s role in the Jan. 6 Capitol attack, a judge ruled.
Republicans are trying to create obstacles to voting for college students, who lean Democratic.
An election for a swing seat on Wisconsin’s Supreme Court has become an expensive political fight.
A.I. is already affecting the 2024 elections, producing fake images of Trump getting arrested and videos that mimic Biden’s voice.
At least 38 people died in a fire at a migrant detention center in Mexico, near El Paso, Texas. The fire started after a protest.
U.S. policies have created overcrowding and desperation at the border.
Lawmakers grilled federal regulators who were supposed to supervise Silicon Valley Bank before it collapsed.
Prosecutors added a foreign bribery charge to the list of crimes already pending against the FTX founder Sam Bankman-Fried.
Alibaba Group, China’s e-commerce giant, is splitting into six business groups.
Other Big Stories
The shooter who killed six people at a Nashville school this week had legally purchased seven guns recently, the police said.
Myanmar’s military dissolved the political party of the imprisoned opposition leader Aung San Suu Kyi.
Russia sent a 13-year-old girl to an orphanage after her father criticized the war in Ukraine.
An appeals court reinstated the murder conviction of Adnan Syed, the “Serial” podcast subject who was freed after more than 20 years in prison, and ordered a new hearing.
The success of Israel’s protests suggests that its democracy is healthier than many feared, Bret Stephens writes.
How can doctors better discuss dying with their patients? Start by trusting them, Dr. Sunita Puri writes.
Stolen painting: He lost a Courbet when he fled the Nazis. His heirs are getting it back.
15-minute city: A professor is getting death threats for his walkable urban design plan.
A discovery: He solved a math problem by finding what’s known as an einstein.
Midday snooze: Can a nap make up for a bad night of sleep?
Advice from Wirecutter: Pick the best VPN.
Lives Lived: Born into poverty in the segregated South, Randall Robinson galvanized Americans against South African apartheid and advocated on behalf of Haitian refugees. He died at 81.
SPORTS NEWS FROM THE ATHLETIC
N.C.A.A. women’s tournament: Iowa vs. South Carolina is the Final Four matchup many wanted — and the one the sport deserves.
A potential $6 billion deal: Multiple bidders have submitted offers to buy the Washington Commanders, including a group that includes Magic Johnson as an investor.
Patriots won’t pursue Jackson: New England is out of the Lamar Jackson stakes, and plans to stick with Mac Jones as its quarterback.
ARTS AND IDEAS
The ever-changing croissant
Apparently there’s no end to the forms a croissant can take.
Ten years after the Cronut, pastry chefs are twisting croissant dough into pinwheels and squiggles, tying it in knots and stacking it into cubes. They are turning it into breakfast cereal, tie-dyeing it and, in one case, wrapping it around baguettes.
When the baker Scott Cioe wanted to lure crowds to Lafayette, a Manhattan restaurant, he turned to croissant dough, coiling it into a photogenic swirl he called the Suprême. “We eat with our eyes as well as our hands,” Cioe told The Times.
PLAY, WATCH, EAT
What to Cook
Try cooking pasta like risotto, adding liquid gradually so that the noodles absorb it completely. The result is a creamy, rich dish.
What to Watch
Rob Lowe and John Owen Lowe star in “Unstable,” a new Netflix series that exaggerates their barbed father-son dynamic.
What to Listen to
Lana Del Rey’s ninth album asks big, earnest questions and isn’t afraid to get messy.
Stephen Colbert called the Nashville shooting horrible and familiar.
Now Time to Play
The pangrams from yesterday’s Spelling Bee were calculator and coloratura. Here is today’s puzzle.
Here’s today’s Mini Crossword, and a clue: Really awesome (four letters).
And here’s today’s Wordle.
Thanks for spending part of your morning with The Times. See you tomorrow. — David
P.S. Nicholas Nehamas is joining The Times from The Miami Herald, to cover Ron DeSantis.
Here’s today’s front page.
“The Daily” is about Israel.
Matthew Cullen, Lauren Hard, Lauren Jackson, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Ashley Wu contributed to The Morning. You can reach the team at [email protected].
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