The Republican strategy for the 2014 midterm elections is not a secret: tie the Affordable Care Act to vulnerable Democrats and hope it will drag them down to defeat. The road to GOP control of the Senate runs through Arkansas, where Rep. Tom Cotton (R) is challenging incumbent Sen. Mark Pryor (D), and Republicans are not shy about their plans to make the Arkansas race entirely about Pryor's vote for the ACA.
This narrative, and its presumption of the ACA's overwhelming political toxicity, finds expression in a December 3 Wall Street Journal article which frames the Arkansas Senate race as a referendum on Pryor's 2009 vote for the health care reform law. "Mr. Pryor's GOP opponent, Mr. Cotton, is making opposition to Mr. Obama and the health-care law the centerpiece of his campaign," the Journal observes. What's missing from the article, for all its assumptions of political fallout from Pryor's support of the ACA, is any recognition of the fact that Arkansas actually represents an unlikely Obamacare success story.
According to the Journal:
Republicans believe Democrats running in 2014 will be hard pressed to distance themselves from criticism of the health-law rollout, as well as the political burden imposed by Mr. Obama's sinking approval ratings.
Mr. Pryor still backs the law but echoes other swing-state Democrats who say it needs fixing. Mr. Pryor supports legislation that would allow people to recover health policies that were canceled because they didn't meet the law's new standards.
The health law was a big part of the political fall of Sen. Blanche Lincoln (D., Ark.), who lost her re-election to Republican Rep. John Boozman in 2010. Democrats hope it will be a far smaller political problem by the midterm elections, assuming the government website continues to improve and the law's benefits come to be felt more broadly.
No one is going to argue that President Obama is popular in Arkansas -- he lost the state handily to Mitt Romney in 2012 -- and it stands to reason that his signature piece of legislation would also be viewed uncharitably. But Arkansas, for all its political hostility to the ACA, is one of the states making health care reform work.
In the south, it is an island of health policy compliance, being one of three states -- along with Kentucky and West Virginia -- to agree to the ACA's expansion of Medicaid. This is owed in large part to the fact that Arkansas' Democratic governor, Mike Beebe, worked with the Republican-dominated state legislature and the Department of Health and Human Services to find a politically palatable compromise for using federal dollars to extend health coverage through private insurers.
The Atlantic's Olga Khazan described how Arkansas arrived at this Medicaid policy emulsion:
There's one thing the state's Republicans are fans of, and that's private enterprise. So earlier this year Beebe called Health and Human Services Secretary Kathleen Sebelius and asked for a special favor. In late September, it was granted: Arkansas got a waiver to use the federal Medicaid money to buy private insurance for the people who would otherwise have been eligible for the Medicaid expansion. The state's legislature had approved this "private option" earlier this year.
Medicaid not only improves health, but also practically eliminates the risk of catastrophic medical expenses from accidents or life-threatening illnesses, so this is good news to low-income Arkansas who would otherwise have been left behind by Obamacare.
Basically, Arkansas won the Chopped challenge of public healthcare problems: Taking a basket of things that totally don't go together, like marshmallows (government entitlements) and fish heads (Republicans) and making a reasonable appetizer (health insurance for the poor) out of it.
And by all accounts, the Arkansas Medicaid expansion is having its intended effect. By the end of October, over 62,000 low-income Arkansans had enrolled for the Medicaid "private option," representing roughly 14 percent of Arkansas' uninsured population.
None of this made it into the Journal article, despite the fact that it cuts against the GOP-friendly narrative that Pryor's vote for the ACA is a millstone around his neck. The law may still be unpopular and Arkansans may still passionately dislike President Obama, but the Affordable Care Act is actually working in Arkansas. Republicans want to ignore that reality and instead focus on the politics of Obamacare, and the Wall Street Journal is helping them do exactly that.
(Flickr Image via stuseeger)