In their rearguard struggle against what they view as ‘socialized medicine’, Republicans vigorously fought to thwart the Affordable Care Act introduced by president Barack Obama that enabled many formerly uninsured people to get much needed health insurance, even though it was very much a capitalist plan, similar to one introduced by Mitt Romney when he was governor of Massachusetts. A real socialist plan would be a government-run single-payer plan which I hope will eventually be put in place. As part of their campaign against it, they derisively called it Obamacare but Obama and Democrats have embraced the name. Now that it has become popular, it will be hard for Republicans to do a switch and claim it for their own.

Despite multiple attempts to repeal it even when they controlled Congress, those attempts failed because Republicans simply had nothing to offer to put in its place. They similarly opposed what is known as ‘Medicare expansion’, a program largely funded by the federal government that would have enabled more low-income people to enroll in the Medicaid program that provides access to health care. That program is run by the states and states with Republican governors and legislatures refused to accept the program, since they do not give a damn about the needs of poor people and were determined to stop anything proposed by Obama that did not benefit the rich. But there were other consequences to blocking the program, one of which was that many hospitals in remote areas shut down because they could no longer get Medicaid funding for treating their poor patients. Since rural areas tend to be Republican, these states were hurting themselves and have belatedly slowly started accepting Medicaid expansion, with North Carolina being the latest, that will allow about 600,000 people in the state greater access to health care.

Ten years ago, Republicans in the North Carolina state House were lining up to vote against Medicaid expansion for their state.

They had an opportunity to open up the program to anybody with income below or just above the poverty line, with the federal government picking up most of the cost through the Affordable Care Act. They passed it up, arguing that the existing Medicaid program was too expensive and too broken. They warned that the federal government might reduce its contributions in the future, and that offering more people Medicaid would give them less incentive to work.

Ten years ago, Republicans in the North Carolina state House were lining up to vote against Medicaid expansion for their state.

They had an opportunity to open up the program to anybody with income below or just above the poverty line, with the federal government picking up most of the cost through the Affordable Care Act. They passed it up, arguing that the existing Medicaid program was too expensive and too broken. They warned that the federal government might reduce its contributions in the future, and that offering more people Medicaid would give them less incentive to work.

Then they said that voting for expansion was tantamount to voting for “Obamacare,” which was politically toxic among Republicans, and even some non-Republicans as well.

Wow, have things changed.

This week, Republicans in the North Carolina House lined up to vote on another expansion bill ― and this time most of them voted for it, with the legislation passing by a total margin of 87 to 24. The vote came a week after the GOP-controlled Senate approved the same proposal by an even more lopsided, 44 to 2, margin.
…

Studies have found all sorts of benefits of Medicaid enrollment, from a reduction in debt and credit problems to better school attendance for kids. Then there is peace of mind ― and, quite possibly, better health ― that comes when people don’t have to ration their heart medication or go without much-needed joint surgery because they can’t afford it.

The article describes the patient grass-roots work by health care activists that led to the change.

David Leonhardt describes the growth of Obamacare and why it keeps winning.

The government benefits began their existence as objects of partisan rancor and harsh criticism. Eventually, though, they became so popular that politicians of both parties promised to protect them.

It was true of Social Security and Medicare. And now the pattern seems to be repeating itself with Obamacare.
…

Obamacare — the country’s largest expansion of health insurance since Medicare and Medicaid in 1965 — is still not as widely accepted as those programs. North Carolina became the 40th state to agree to expand Medicaid under Obamacare, which means that 10 states still have not, including two of the largest, Texas and Florida. In those states, more than 3.5 million adults lack health insurance as a result.

But the list of states signing up for the program seems to be moving in only one direction: It keeps growing.
…

In the initial years after Obamacare’s passage in 2010, [Medicaid expansion] was similarly divisive. Blue states embraced it, while many red states rejected its voluntary Medicaid expansion. In Washington, congressional Republicans and Donald Trump tried to repeal it. Some Republican-appointed judges invalidated parts of it, and every Republican appointee on the Supreme Court except Chief Justice John Roberts voted to scrap the law.

Twice, it survived by a single vote — first, by Roberts’s 2012 Supreme Court vote, and then by Senator John McCain’s late-night vote against its repeal in 2017. Since then, however, Obamacare has been gaining Republican support.

The next year, voters in Idaho, Nebraska and Utah — red states, all — passed ballot initiatives expanding Medicaid. Oklahoma, Missouri and South Dakota have since done so. Montana’s state legislature has also approved an expansion.

In 2019, Gov. Andy Beshear of Kentucky, a Democrat, narrowly won election in a Republican state by pledging to protect an earlier Medicaid expansion. In North Carolina, Roy Cooper, also a Democrat, became governor in a 2016 upset partly by campaigning in favor of an expansion — and was able to sign one this week.

The consequences of not accepting it have been serious, especially for rural areas.

Even with its flaws — including its often complicated process for signing up for insurance — [Obamacare] has achieved many of its aims. The number of Americans without health insurance has plummeted. In states that have refused the Medicaid expansion, by contrast, rural hospitals are struggling even more than elsewhere because they do not receive the law’s subsidies for care.

Greenwood Leflore Hospital — in the Mississippi Delta — is an example. It recently closed its intensive-care unit and maternity ward, as our colleague Sharon LaFraniere has reported. Nationwide, states that did not quickly accept Medicaid expansion have accounted for almost three-quarters of rural hospital closures between 2010 and 2021, according to the American Hospital Association.

Similar problems in North Carolina were a reason that Republicans there reconsidered their opposition to Medicaid expansion. “We had these people coming down to Raleigh, farmers, business owners, people from rural areas, they were advocating, telling stories,” one Republican state representative told HuffPost.

Many Republicans still oppose Obamacare, and some hard-right members of Congress also favor cuts to Medicaid — as well as to Medicare and Social Security. In a country as polarized as the United States, there isn’t much true political consensus. But Obamacare has won over the political middle more quickly than seemed likely not so long ago.

Republicans found that while ‘repeal and replace Obamacare’ was a catchy slogan, they could offer nothing to replace it with that would appeal to voters and hence their repeal efforts kept failing. Their major losses in Congress in the 2018 mid-terms elections that saw Democrats gain a big majority in the House of Representatives was largely attributed to their efforts to overthrow Obamacare. I think that they have finally seen the writing on the wall.