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Why it’s hard to keep voters scared about Obamacare repeal

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Senate Democrats want to make the month of August about their ideas on health care, Politico reported today. They are envisioning a sort of hilarious call and response, the dorkiest summer concert series of all time:

Every time they say “nominations,” we’ll say “lower premiums.” When they say “appropriations process,” we’ll say “bring down drug prices.”

Though the messaging is novel, the strategy isn’t actually all that new.

Since early May, I’ve been getting regular updates on the “Trump-GOP Health Care Sabotage” from Senate Democratic leader Chuck Schumer’s office. Democrats have been saying for months that voters should hold Republicans and the Trump White House responsible for any future problems with the law. Trump, after all, cut off the law’s cost-sharing reduction subsidies (which led insurers to hike their rates for 2018), and Congress repealed the individual mandate (for which insurers will hike their rates in 2019).

And, of course, Republican tried to pass Obamacare repeal bills last year that would have led to millions fewer Americans having health insurance. That is still officially the GOP position.

Democrats see this as a winning 2018 campaign strategy, particularly with 2019 premiums set to be finalized in October, mere weeks before voters go to the polls. As Vox’s Ella Nilsen reported last month:

Insurers in Virginia and Maryland recently announced they are seeking steep rate hikes on some of their Obamacare exchange plans. One company called CareFirst, which covers 15,000 people in Maryland, is proposing to raise rates by 91 percent, with premiums as high as $1,334 a month for a 40-year-old.

Senate Democrats have seized on this, and on Tuesday, they made it clear they are going to hammer the point home from now until the fall.

“When those rates go up, coverage goes down,” Senate Minority Leader Chuck Schumer told reporters Tuesday. “It’s important to remember, President Trump and congressional Republicans are fully responsible for the significantly higher premiums and millions fewer people insured.”

They have good reason to think it’s a winner. On the issues, health care ranks toward the top for American voters, and the public has said pretty consistently that Trump and Republicans are responsible for the success or failure of Obamacare going forward.

Kaiser Family Foundation

The Kaiser Family Foundation released findings in March that 63 percent of Americans thought Congress should focus on improving Obamacare; just 32 percent thought they should focus on repealing it. In an earlier poll, 71 percent said lawmakers should try to make it work and just 21 percent said they should let it fail.

Democrats have the public on their side. But I think there’s nonetheless a big challenge for them on health care.

This is a hunch, but one shared by pollsters and informed by years of watching health care politics: I think Democrats do have to fight against health care fatigue. Obamacare repeal was hugely unpopular, and it was also the biggest politics story of the 2017 summer. But that was a year ago.

Graham-Cassidy had a brief moment in September, but since then, the ACA has felt safer. Nobody is taking the latest repeal rumors too seriously, probably because the votes aren’t there for Republicans right now.

That means that for more than a year, Democrats have had to keep reminding voters that Republicans tried to take health care away from 20 million people.

Repeal was a clean, simple, and big story. “Sabotage” — in the form of cutting CSRs, expanding non-Obamacare insurance, and slashing outreach — is more nebulous. People still care about health care, but they aren’t hearing about it in the news every day anymore. The threat on health care can feel less real, even if sabotage is having very concrete effects.

You can see it, at least indirectly, in the law’s approval rating. The ACA’s popularity started trending upward last spring, as House Republicans tried to pass their repeal bill. It hit new heights after surviving the Senate and the revival of Graham-Cassidy in September. But it seems to dip a bit when it’s been in the news less, like in April, when it fell below 50 percent for the first time in six months.

Kaiser Family Foundation

To be sure, some of this is probably statistical noise, but I think the surge in popularity during last year’s repeal crusade points to a real phenomenon here: When the ACA faces an existential threat, the public will come to its defense; when it fades out of the news, it can slip to a more divisive status quo.

This is why Democrats are preparing to respond to every Republican initiative with, “But health care!” The biggest risk for Democrats in the 2018 elections, as far as health care is concerned, is complacency.

But hey, how else are they going to use the time Mitch McConnell got them from canceling August recess?

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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