A former Arizona state senator named Russell Pearce resigned as vice chairman of the state's Republican Party recently because he suggested that if he ran Medicaid, the first thing he'd do would be to put female recipients on birth control implants or require tubal ligation. Then he'd test all recipients for drugs and alcohol. If you want to reproduce or use drugs or alcohol, he reportedly told listeners on his radio show, "then get a job."

It's not surprising that a conservative Republican might perceive poor people as lazy and irresponsible, but the attack on Medicaid — the government-financed insurance program for the poor and working poor and, of course, the possibility of forced female sterility — was beyond the pale. Even fellow Arizona Republicans were appalled by such hateful and insulting comments.


What's notable here is not just that some ex-politician with a radio show went too far on the subject of women's health care (although one does wonder what kind of ruckus ensues at Republican gatherings when the anti-contraception wing confronts the pro-Norplant crowd) but that the political ground on health care is shifting more broadly and dramatically. One by one, Republican governors are accepting expanded Medicaid coverage in their states, and the evidence of Obamacare's success — both in millions more families gaining health insurance coverage and in constraining health care costs — have become overwhelming.

A year ago, the Affordable Care Act looked like the best thing Republicans had going in the mid-term elections. Now, not so much. The repeal of Obamacare might still come up in races in the Deep South or other rock-bed conservative venues, but it's not getting nearly as much discussion compared to a year ago when GOP members of Congress were ready to shut down the government simply to delay its implementation.

The latest estimates by the Centers for Disease Control and Prevention suggest the health care law has reduced the number of American adults under age 65 without health insurance by two percentage points in the first quarter of this year alone — and that likely understates the impact, given the surge of enrollments toward the end of the open enrollment period this spring. Preliminary estimates also suggest health insurance premiums will rise modestly next year and not by the disastrous rate that critics have long predicted. And inconveniently enough for Republicans, the two biggest success stories in expanding health insurance coverage have come in the deep red states of Arkansas and Kentucky.

Even in Maryland, which experienced one of the worst rollouts of any health exchange in the country, one has to wonder if Republican gubernatorial candidate Larry Hogan will get much traction in his attacks on Lt. Gov. Anthony Brown. Not because Mr. Brown's involvement in the exchange isn't still murky but because the public is not so dissatisfied with the ACA to be particularly upset that the online marketplace was initially handled poorly.

The Affordable Care Act still has its share of problems — premiums are still too high for many Americans, gaps in coverage exist and more needs to be done to constrain rising health care spending — but it appears to be falling off the radar screen as a political issue for most Americans. While polls still show a majority oppose health care reform when it's described as "Obamacare," its importance to voters has dropped behind jobs, the economy and immigration.

It's bad enough to attack the poor for being poor when jobs are in such short supply but to attack them for being sick or pregnant? Sorry, but those who seem to think people who can't scrape enough money to buy food, clothing or shelter should be investing in a health care savings account aren't living in reality-land. Getting medical attention isn't regarded as an indulgence in the vast majority of the industrialized world, it's considered a basic human right.

We don't know how many Democrats will run TV ads between now and November bragging about the Affordable Care Act or their support of it, but we do know our elected leaders ought to be discussing ways to make it better. After all, the goal here is to reduce the ranks of the uninsured and support as much privately-financed health insurance as possible. Surely, some common ground can be found between those who see expanded insurance coverage as a blessing and those who see only the burden to employers and the affluent.

It's a good sign that Mr. Pearce didn't find a lot of support for his point of view and that Democrats weren't the only ones quick to condemn it. But merely ignoring Obamacare and its successes — as well as shortcomings — isn't enough. People in this country still pay too much for too little return in medical care to leave well enough alone.

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