How We'll Talk About the Affordable Care Act in the Fall

Since these are the Republican primaries, the GOP candidates talk about the Affordable Care Act as though it were making your life a living hell, getting you fired from your job, and maybe kicking your dog as well. They all pledge to repeal it the instant they get into office, though they're vague on how exactly they'd go about it, since in our system, the president doesn't get to cancel duly elected laws he doesn't like. This is obviously what the Republican base wants to hear. But what about when we get to the fall?

The broader electorate's views on the ACA are both more positive and less clear than those of the GOP base. They don't have the same kind of visceral reaction against it, but neither are they likely to believe it's been a boon to them. That's because most of the key provisions, particularly the mandate to carry insurance, the subsidies for people to get it, and the creation of the insurance exchanges, won't take place until 2014. But that doesn't mean the ACA hasn't already started to show benefits.

As TNR's Jonathan Cohn explains, newly released data show that although the number of uninsured has risen among people over 25 (exactly what you'd expect given the poor economy), the number of people between the ages of 19 and 25 without insurance fell by 2.5 million during 2011. Why? Well, one of the provisions of the ACA that has taken effect mandates that young people be allowed to stay on their parents' insurance until the age of 26. What do you know: A regulation designed to help people not be uninsured leads to fewer people in the target population without insurance.

Like most of what's in the ACA, this provision is extremely popular, which is why most of the Republican candidates have said they'll keep it. And this is essentially their line about almost all the ACA's provisions, with the exception of the individual mandate that makes the whole package possible. Oh, outlawing denials of coverage for pre-existing conditions? Of course I'd keep that. And forbidding insurance companies from kicking you off your coverage if you get sick? Of course I'd keep that. And ending lifetime coverage caps, so if you get a serious illness you won't go bankrupt? Of course I'd keep that. But we must repeal Obamacare!

When we get to the general election, "Repeal Obamacare!" isn't going to be such an applause line. And you can bet that the Obama campaign is going to run ads saying, "Newt Gingrich wants to let insurance companies deny you coverage if you have a pre-existing condition." He (or whoever the nominee is) will protest that he wants to do no such thing, and it's the most vicious of lies. He just wants to repeal the law that forbids insurance companies from denying you coverage if you have a pre-existing condition.

As you can see, in the back-and-forth, Obama will probably have the advantage, since he'll be able to talk about specific terrible things his opponent wants to do to people, while it will be much harder for the Republicans to talk about specific terrible things the ACA has done to people. As so often happens, the Republicans will have an advantage if the discussion stays abstract, while the Democrats will be at an advantage if the discussion gets specific.

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