Are Republicans really anti-exchange?

The following are all quotes from the paper “Pascal’s Wager: Health Insurance Exchanges, Obamacare, and the Republican Dilemma,” by David Jones and Jon Oberlander (forthcoming in the Journal of Health Politics, Policy and Law, February 2014).

  • “In a June 2010 Kaiser Family Foundation survey, 87 percent of all respondents—including 77 percent of Republicans— said they had a very or somewhat favorable opinion of exchanges.”
  • “62 percent of self-identified Republicans had very or somewhat favorable opinions of exchanges in a December 2011 poll.”
  • “[N]ine of the seventeen states that eventually decided to operate state-based exchanges had either a GOP governor or a Republican majority in at least one house of the legislature when the decision was made.”
  • “Strikingly, the only state with a Republican governor and Republican-controlled legislature that chose to create its own exchange— Idaho—is by at least one measure the most conservative state in the country.”
  • “[A]pproximately 90 percent of Republican legislators in Nevada and Hawaii voted to establish exchanges, as did more than 90 percent of Republicans in the lower chambers of the Alabama, Missouri, and North Carolina legislatures.”
  • “If we count only post-ACAvotes in states where legislators in at least one chamber voted, 42 percent of Republicans voted for exchanges through February 2013.”
  • “[I]nsurance exchanges drew relatively little fire from Republicans during the 2009–10 health reform debate. Moreover, prominent GOP leaders supported the concept even as they fought for the ACA’s repeal. Senator Coburn (R-OK) (2011), for example, continued to back ‘state-based efforts to create free-market, voluntary health insurance exchanges,’ though he distinguished them from the ACA’s ostensibly more onerous exchanges.”

You can read the paper yourself and draw your own conclusion. My view is that Republicans are not generally, ideologically opposed to exchanges. Deep down, I think any pro-market health reformer knows exchanges are sensible. Consequently, at least some of the broad structure of the Affordable Care Act should be appealing to conservatives. To the extent elected officials most sympathetic to right-of-center health policy aren’t behaving accordingly, there would seem to be a disconnect between policy preferences and political tactics.* As I tweeted earlier this week:

* Just so you don’t have to, I will accuse myself of putting it mildly.


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