The American people like new social programs as a general concept. Ask voters whether they would like to see Uncle Sam provide universal health care, or child-care subsidies, or paid family leave, or a variety of other new welfare benefits, and most will answer in the affirmative.
On the other hand, Americans are rather averse to taxation and distrustful of their governing institutions. And voters also tend to evince status-quo bias and loss aversion. (For example, despite the objective monstrousness of America’s health-insurance system, a majority of voters consistently express satisfaction with their own existing coverage.) All this contributes to the “thermostatic” nature of American public opinion, which reliably grows more conservative when Democrats are in power, and more liberal when Republicans are.
For these reasons, Democratic efforts to create ambitious new welfare programs can be politically dicey, even when the objectives of said programs are broadly popular. It is now quite clear that the American people prefer the Affordable Care Act to the pre-2009 health-care-policy regime. For all Obamacare’s flaws, its expansion of Medicaid and establishment of protections for individuals with pre-existing conditions render it a vast improvement on what came before in the eyes of the median voter. But this did not prevent Republicans from effectively stoking the public’s status-quo biases during the fight over the ACA. In fact, CNN’s final poll before Barack Obama signed his health reform into law found Americans opposing its passage by a margin of 59 to 39 percent. In the ensuing midterm bloodbath, Democratic lawmakers who voted for the ACA were more likely to lose their seats than those who did not.
And yet, if Democrats can expect little thanks for expanding social provision in the immediate term, they tend to eventually reap political benefit from doing so in the long run: Once voters get to know a new social welfare program, they tend to like it. And once a new program is on the books, a switch gets hit — and the public’s status-quo bias starts working in progressives’ favor. The conservative movement just can’t help itself. No matter how popular a new welfare program proves to be, it will wage a holy war for its repeal. And when they do, Democrats tend to capitalize on the electorate’s fears of reactionary change.
Lyndon Johnson’s party took a beating in the first midterm after Medicare’s passage. But they’ve been mining public fears of Repulican cuts to the program for electoral gain ever since. Polls consistently find that voters trust Democrats more than Republicans to properly administer Medicare and Social Security. Meanwhile, political-science research has shown that the enactment of those programs helped to politicize their beneficiaries: As America’s seniors came to appreciate the stakes of partisan conflict — and fear the loss of their little slices of socialism — their rates of voter participation greatly increased. (Donald Trump’s triangulation on entitlements is an underrated aspect of his 2016 success.)
In the last two years, Obamacare in general — and Medicaid expansion, in particular — have begun paying political dividends. Many factors contributed to the 2018 “blue wave” that drowned Paul Ryan’s House majority. But his caucus’s ill-fated attempt to roll back the Affordable Care Act was unquestionably a major one. Now, in just the last few weeks, Democrats have mined the public’s appreciation of the Medicaid expansion — and aversion to losing it — to score gubernatorial victories in some of America’s reddest states. Earlier this month in Kentucky, Democratic Attorney General Andy Beshear rode public antipathy for Governor Matt Bevin’s assaults on the low-income health program — and his handling of public education (another well-entrenched social program that conservatives must pretend to support) — to the governors’ mansion of a state that went for Trump by 30 points in 2016. And this past weekend, Louisiana’s incumbent Democratic governor John Bel Edwards replicated Beshear’s success. As the Washington Post’s Greg Sargent reports:
In Louisiana, Edwards ran multiple TV ads featuring ordinary people with serious health problems talking directly to the camera — see here or here — about how much they relied on the Medicaid expansion, which covers nearly half a million people.
Edwards also ran ads savaging the health-care plans of his GOP opponent businessman Eddie Rispone, who seriously fudged his intentions but left no doubt that he’d dramatically alter the program and potentially roll it back.
“We were explicit in the role the governor played to expand Medicaid and the risks Rispone posed to it,” [Zac] McCrary, Edwards’s lead pollster, told me. “No single issue was more important than the Medicaid expansion.”
…Importantly, McCrary noted that the Medicaid expansion was not perceived by Louisiana voters as primarily an issue involving the urban poor or minorities. Indeed, he said, it was seen as a positive selling point for Edwards among the moderate and suburban whites whose alienation from the Trump-era GOP is so often discussed these days.
There’s some evidence that the Medicaid expansion — like Medicare and Social Security before it — has awakened its constituency to the power of government to improve their lives, and thus, to the importance of civic participation. As the progressive think tank Data For Progress noted in a recent report, multiple studies have found that when states expand Medicaid, they see a significant uptick in voter turnout in subsequent elections.
It’s unclear what role (if any) heightened turnout among new Medicaid beneficiaries played in Kentucky and Louisiana. But bipartisan aversion to rolling back healthcare for the poor was unquestionably central to Democratic success.
One lesson that the Democratic Party could take from all this is to swing big if and when they secure control of the federal government: After all, any major policy change is liable to trigger a thermostatic backlash in the immediate term — but the more people your new programs ultimately help, the bigger the downstream political benefits are likely to be. (Unless Republicans pull an Eisenhower and make peace with your new dispensation, in which case, you’ll just have to settle for durably improving people’s lives.)