The risks and rewards of the Obamacare repeal “veto-bait”

This week, Senate Republicans succeeded in doing what their House counterparts have already done nearly 60 times since 2011: pass a bill repealing significant parts of the Affordable Care Act. They did so using a special set of procedures, known as budget reconciliation, that prevent a measure from being filibustered.

The Senate has a long history of utilizing reconciliation’s procedural protections to enact substantial, high-priority policy changes. This year’s use of reconciliation, however, is different, as President Obama has promised to veto the bill. As I pointed out in October, the best way to understand Republicans’ efforts is as an example of what political scientists call “veto bait.” (Of the 23 reconciliation measures debated since 1980, only two others—tax measures in 1999 and 2000—can be characterized this way.) The logic of these “blame gamevetoes is straightforward: Congress passes bills it knows the president will veto in order to draw stark distinctions between the positions of the two branches. In attempting to enhance their own partisan image in the eyes of voters while damaging the reputation of the opposite party, this use of vetoes is consistent with broader patterns in what political scientist Frances Lee has termed “partisan teamsmanship” in the Senate.

Symbolically, the benefits to Senate Republicans of passing a piece of veto bait through the reconciliation process are clear. After all, the promise of an attempt at repeal was among the chief messages of many Republican Senate candidates in 2014. Research by Tracy Sulkin tells us that, for senators, more follow-through on campaign promises corresponds to a higher chance of re-election. For some Republican senators, this desire to follow through may be especially acute given that they lack their House colleagues’ track record on the issue. Because all participants know, moreover, that the president will not sign the measure, Senate Republicans did not face the pressure that would ordinarily arise under divided government to moderate the bill in pursuit of the executive’s signature.

The fact that Senate Republicans faced no incentive from the president to pass a more moderate reconciliation bill, however, did not necessarily mean they were in the clear electorally. As several media reports have noted, eliminating benefits, such as the Medicaid expansion and tax credits to help individuals purchase coverage, could have consequences for the Senate Republicans’ efforts to maintain the majority in 2016. A number of studies in political science have suggested that voters are sensitive to changes in the specific federal benefits they receive, and the 2016 electoral map disadvantages Senate Republicans, as they are defending 24 seats to the Democrats’ 10. Of the 12 seats rated as most likely to change hands by Hotline, moreover, 10 are held by the GOP, including six in states that have chosen to embrace the ACA’s Medicaid expansion.

Why weren’t Senate Republicans more concerned about these possible electoral consequences? First of all, for Republicans to be punished at the ballot box, the individuals who oppose the policy change—even a hypothetical one, like the reconciliation bill—must actually turn out to vote. As multiple reports noted after Kentucky Governor-Elect Matt Bevin (R) was elected on a promise to roll back that state’s Medicaid expansion, the lower-income individuals who benefit from Medicaid are less likely to head to the polls; politicians, in turn, feel little political pressure to provide such benefits.

Second of all, an examination of the actual geographic distribution of the ACA’s benefits suggests that any negative effects of even a symbolic repeal would not necessarily be felt disproportionately in states where Republicans are defending seats next fall. Take, for example, the tax credits that subsidize individuals’ purchase of health coverage on the insurance exchanges. Evidence suggests that beneficiaries of these subsidies aren’t over-represented in states where Republicans are defending seats in 2016. In the 24 states where Republican seats are up next year, an average of 2.6 percent of the population has received financial assistance through the premium tax credits. In the other 25 states for which data are available, that figure is 2.2 percent. (The data on the number of beneficiaries comes from the Center for Medicare and Medicaid Services’ June estimates of participation, and the data on total state population comes from the Census Bureau’s most recent population estimates). Restricting the analysis to the share of the eligible population receiving tax credits yields similar results. Estimates from the Kaiser Family Foundation suggest that, in states where Republicans are defending seats in 2016, an average of 51.2 percent of those eligible for tax credits received them. In the 25 other states, that average is a statistically-indistinguishable 51.8 percent. If Republican candidates for Senate were punished in 2016 for their vote on the repeal, then, it’s not clear that those effects would be especially acute in the states that are key to retaining the GOP majority.

Finally, Senate Majority Leader Mitch McConnell (R-KY) and other drafters of the package took advantage of an important, but sometimes overlooked, feature of the reconciliation process to help build support for vulnerable incumbents. As the Congressional Research Service notes, reconciliation is generally used as a deficit reduction tool, but individual measures often contain targeted spending increases, which could serve as important credit claiming opportunities for Republican members even after the measure is vetoed. Take, for example, the provision in the repeal bill that would roll back planned cuts to supplemental payments to hospitals that serve a large number of Medicaid and uninsured patients. If implemented, these reductions are expected to hit hospitals in states that have not expanded Medicaid especially hard, and the GOP has come under fire from influential hospital groups for their opposition to expanded coverage under the ACA. For the thirteen Republicans running in 2016 in states that rejected the Medicaid expansion, this targeted spending increase could help smooth over relationships with key interest group allies.

Because they subvert the filibuster, the reconciliation rules are an especially attractive tool for the majority party in the Senate to pass bills that it thinks will be electorally valuable. Historically, that has generally meant approving legislation that is eventually signed into law. This year, however, the circumstances are different, and a piece of veto bait appears to be the most electorally advantageous move. We’ll have to wait until November 2016 to see whether it works.