Anonymous at Work asked a great question yesterday as we discussed ACA entrenchment in Southern States:
What’s causing the dam to break, especially in Texas? North Carolina, Republicans are preemptively removing a potent political weapon for Democrats. Georgia, I figure, might be the same.
I figure Texas is about money, since it’s always about money in Texas. Does Texas have a chance at running a decent state marketplace in a state dedicated to never taxing and never spending money?
I want to speculate.
The ACA was the center of American political disputes from 2009-2018. It ate up a lot of attention. It ate up a lot of news cycles. It ate up a lot of effort and time. By the end of 2017, it had survived two substantial Supreme Court challenges and a Republican trifecta that got to within one vote of massive Medicaid cuts and a systemic reconstruction of the individual market. It survived the 26 Governor strategy last ditch attempt of Graham-Cassidy-Heller. It survived and it was doing a good enough job; not a great job, but good enough job.
And then the ACA and Silverloading in 2018 distributed massive benefits to rural areas that directly addressed a substantial concern about benefits not being good enough for too much premium for some of the upper part of the subsidized distribution and reinsurance waivers took the edge off the pain for non-subsidized buyers. Concurrently, deeply conservative/Republican tilting states started to consistently vote for Medicaid expansions that local elites did not want. The Republican governor of Kentucky, Bivens who was a fierce opponent of the ACA, lost a nail-biter race for re-election in the fall of 2019.
There is just less energy on the right on the matter of the ACA and healthcare at the local and state level. It is not a motivating driver right now as it is becoming part of the background noise and the world has not ended because more people can afford to go to the doctor’s office and pick up a prescription.
The shiny object moved on.