As the big GOP push for Obamacare repeal begins, many Republicans in congress are begining to realize that “Hot damn, we got rid of Obamacare” is probably not going to play all that well with constituents who have their health care coverage eliminated, diminished or made more expensive.
The privatization enthusiasts in the GOP, at least those who believe that the private sector can do no wrong, haven’t quite gotten it yet. For them, unleashing the ‘magic of the market’ as a sacred principle of conservatism is reason enough to trash the Affordable Care Act. Whether they get away with it or not depends on the economic demographics and ideology of their district electorates.
At New York Magazine Jonathan Chait describes the Republicans’ predicament:
After the election unexpectedly put them in full control of government, I predicted they would follow a “repeal and delay” plan, because it is the only way to keep the lie going. The closer they get to taking action, the more clear it becomes to Republicans that their own propaganda has trapped them and given them no escape. Railing against Obamacare was easy, but the responsibilities of power have taken all the fun out of denying medical care to the poor and sick.
…In a free-market system, tens of millions of Americans will not be able to afford medical care because the cost of their treatment exceeds their income, either because they’re too poor, or because they’re too sick. A Kaiser Family Foundation analysis finds that 52 million Americans under the age of 65 have preexisting conditions that would make it impossible for them to purchase health insurance in the individual market that existed before Obamacare. An insurance-industry study from 2008 found that 13 percent of people who applied for coverage in the individual market were rejected — a figure that doesn’t even count the 34 percent of people who had to buy policies that excluded coverage of treatments for their preexisting conditions, let alone those who didn’t even bother applying because they knew they couldn’t afford it.
Covering people who can’t afford to pay for their own medical care means making other people pay for it. You can do that through direct tax-and-spend transfers, or through indirect regulatory methods (like making insurance companies overcharge healthy people and undercharge sick ones). Republicans oppose these methods because they oppose redistribution in general. And yet politics requires them to promise a plan that does not deprive Americans of access to treatment. This is the reason none of their plans has advanced beyond the white-paper concept phase —either they contain too much redistribution to be acceptable to the GOP, or too little coverage to be acceptable to the public, or both.
Chait adds an important insight Repubicans don’t want to face, and one which Democrats must embrace as a central principle of health care reform: “The health-care plans people like are ones such as Medicare, or employer-sponsored insurance — plans in which all customers pay the same rates regardless of age or preexisting conditions, and which don’t put them at risk of paying out huge costs if they get sick.”
Instead, argues Chait, the Republicans are wedded to “threadbare, catastrophic coverage with enormous deductibles.” They know this is a tough sell, and the “replace” part of “repeal and replace” promises to give Republicans in competitive districts an exended migraine headache for months, if not years, to come.
Chait likens the proposed GOP strategy of peacemeal replacement bills to an episode of The Simpsons, in which Homer, faced with certain failure in a test, says “I’ve been working on a plan. During the exam, I’ll hide under some coats, and hope that somehow everything will work out.”
“Repeal-and-delay,” adds Chait “is the ultimate backhand acknowledgement that the party has no answers. Their wan hope is that by repealing the law, they can satisfy the blood lust of conservative activists. The repeal won’t take place for years. Then they can hide under some coats and hope it all works out.”
As you might imagine, health insurance companies are not eagerly looking forward to such a scenario — yet another example of the political party that purports to be the champion of pro-business policies introducing new chaos and uncertainty into the markets.
As for emerging scenarios, Chait sees one coming into focus:
The most likely answer is that Republicans never craft a replacement. They repeal Obamacare, but delay the effective date of the repeal, and then Obamacare becomes a “cliff” that Congress votes to keep extending. There is no majority in Congress behind any one specific plan to replace Obamacare, but there is probably a majority against blowing it up immediately. That will likely become the new status quo. There’s no transition to a new plan. The transition is the plan. Or, at least, it will be…The most likely outcome is that Republicans keep extending the law until Democrats have the presidency again, at which point they’ll no longer have an incentive to prevent mass suffering, and can go back to opposing anything Democrats try to do to make the system work. Republicans just need to keep the system from collapsing on their watch.
Paul Krugman writes in his latest New York Times column,
In a way, Democrats should hope that Republicans follow through on their promises to repeal health reform. After all, they don’t have a replacement, and never will. They’ve spent seven years promising something very different from yet better than Obamacare, but keep failing to deliver, because they can’t; the logic of broad coverage, especially for those with pre-existing conditions, requires either an Obamacare-like system or single-payer, which Republicans like even less. That won’t change.
As a result, repeal would have devastating effects, with people who voted Trump among the biggest losers. Independent estimates suggest that Republican plans would cause 30 million Americans to lose coverage, with about half the losers coming from the Trump-supporting white working class. At least some of those Trump supporters would probably conclude that they were the victims of a political scam — which they were.
Republican congressional leaders like Paul Ryan nonetheless seem eager to push ahead with repeal. In fact, they seem to be in a great rush, probably because they’re afraid that if they don’t unravel health reform in the very first weeks of the Trump era, rank-and-file members of Congress will start hearing from constituents who really, really don’t want to lose their insurance.
Krugman notes also that Republican Obamacare repeal mania is fueled in part by the GOP’s opposition to the higher taxes on the wealthy needed to fund the ACA and, not incidently, because the latest enrollment figures are “running ahead of their levels a year ago,” a strong indication that Obamacare is working.
So the charade continues at the taxpayers expense. The scary part is that the likely scenarios sketched by Chait and Krugman are the optimistic outcomes. If lunacy prevails over their normal economic mismanagement, and the Republicans go ‘The Full Monte’ on privatization, it could get a lot worse.
It’s regrettable that Democrats have to spend so much time defending the only major health care reform to benefit millions of Americans since the days of LBJ. But if the experience clarifies the moral and intellectual bankruptcy of the Republicans and their equivocating candidates, Dems might get some electoral benefit as early as 2018.