DC Deciphered

Republicans can’t avoid it.  And I guess I can’t avoid it anymore either.  It’s Obamacare.  (Obamacare of course is officially named the Affordable Care Act, but since we’ve all known it as Obamacare for years now, I’m going to make it easy and just call it that here).  Republicans have been really hearing it loud and clear from constituents who are angry or worried about the GOP plan to repeal Obamacare and replace it with some as yet undefined new plan.

 

Last week’s news was filled to the brim with reports of rowdy town hall meetings, which were about a range of topics, but overwhelmingly centered on Obamacare repeal.  Many Republicans did try to avoid this entirely by simply refusing to schedule town halls, but for the Party as a whole, the issue of what the heck to do about their promise to “repeal and replace” was just smacking them in the face all week. And some – it seems – are going a little wobbly at the prospect of taking insurance away from millions.

As for me, I’ve been avoiding the topic as well.  Since I began this blog I’ve wanted to write about Obamacare several times, yet every time, I’ve found it impossible to begin. That’s because the topic is one I’ve been very passionate about ever since watching the way Republicans so badly distorted the entire conversation over health reform by spilling an endless flow of outrageous lies throughout the entire Obamacare process (from drafting the bill, to passage of the law, to implementation, right up to today).  That makes it hard for me to express what I want to say on the topic clearly and succinctly.  Especially since there’s just so, so much to cover, from so many different angles.  But now I’m going to try, starting with just a small piece of it.

First, it’s only fair for me to address the fact that I just accused Republicans of a mountain of lies about Obamacare.  I don’t like to make an accusation like that without backing it up.  But since that takes us off of the main topic I really want to address here & sends us delving into the past, I wrote a separate post on that so as not to distract from my main focus.  And most of you probably remember how it all went down and don’t need to read a rehash anyway.  But for those that want or need backup of my claim, or just need a refresher on some of the history, you can read the other post here.

The GOP Never Came Up With a Plan

So in addition to some very specific false claims about the substance of the law, Republicans have spent the last 7 years criticizing Obamacare more generally as a  government takeover of healthcare, the death of freedom, a job killing nightmare, etc. They attacked it as unconstitutional and acted as if its enactment was basically the end of democracy.

They’ve tried to kill it with numerous lawsuits (some still ongoing), several of which reached the Supreme Court, including the most well known case over the constitutionality of the individual mandate.  They have  voted to repeal or alter the law more than 60 times.  They’ve been promising since pretty much the day it was passed to repeal it (a promise which eventually became “repeal and replace”).  And they’ve succeeded – primarily through the years-long series of fear-inducing lies – in convincing their base that there is no more important priority on earth than repealing this hideous law.  (Half of Trump voters want to see Obamacare repealed entirely.  But remember, Trump voters only represent about 25% of the voting age population!)

But in 2017 they’ve found themselves with a little problem, because in those seven years of complaining about Obamacare and promising to repeal and replace it, they never bothered to actually come up with a replacement.  That’s because they never really wanted to replace it, and the true hope was that they’d be able to repeal it before the law actually went into effect (remember that though Obamacare was passed in 2010, the new insurance plans didn’t kick in until 2014.  So this strategy rested on Mitt Romney winning the 2012 presidential election). Republicans knew that once people actually started getting their new insurance through Obamacare, it would be very hard to take it away.  Repealing the law before anyone actually began to experience any of the benefits would have been much easier for them and likely wouldn’t have caused much political backlash.  In that case, they probably could have gotten away with offering no replacement plan at all without any consequences. Not so in 2017.

In the Meantime, People Started to Benefit from Obamacare

Not only have a lot of people (estimated somewhere between 14 and 20 million) gained insurance through Obamacare, most are quite happy with that insurance. And people have discovered that all the terrifying things they were told were going to happen because of Obamacare weren’t true.  There are no death panels, we’ve had 75 straight months of job growth, and the country is still standing (for now!).  While Obamacare is still not overwhelmingly popular, it has become more popular over time and recent polling has it at its most popular level ever.

(And it’s true the law is not perfect. It’s functioning better in some locations than others: in some places there’s not enough competition, as certain spots have been left with only one or two providers after some companies left the market, not as many young, healthy people have signed up as they had hoped for, and the network offerings are too narrow in some locations.  Though many people are happy to choose a narrow network if it means lower premiums.  But the thing is, if you terrify people with death panels and the end of freedom, as the GOP did at top volume, for years before the law was even implemented, then it’s a relief when the law finally gets going and it turns out narrow networks are the worst of your worries.  So overall, most people are pretty content with the law and even many of those who aren’t have tempered their opposition).

And the individual elements of Obamacare are almost all overwhelmingly popular and have been since the beginning.  The one aspect of Obamacare that has always been unpopular is the individual mandate, which is the key to making the other main elements work.   Two of the most well-know provisions of the law are both extremely popular.  These are the provision that bars insurance companies from discriminating based on preexisting conditions and the one that allows customers to stay on their parents insurance up to the age of 26. While most people would like to see some sort of fixes to the law, few (only 26% overall, or even less in some polls) would like to see it entirely repealed.   And lots and lots of these people are showing up at town halls and members’ offices, and writing letters and emails and signing petitions to let GOP Congressmembers know – in no uncertain terms – that they do not want their “Obamacare” taken away from them.*

The GOP Had to Adapt to the New Reality

And as this shift in public sentiment over the law was developing, Republicans underwent a shift in the way they talked about health care reform.  They went from a singular focus on repealing the law and saving Americans from the “shackles” of forced health insurance, to now sounding a bit more like Democrats when they speak about health care.  While there is still some GOP talk of “restoring liberty” when discussing Obamacare repeal, go to most any town hall these days and you’ll hear Republicans talking about making sure no one loses health insurance and occasionally even hoping to make sure even more people can get it.  You’ll hear almost all of them promise to keep protections for people with preexisting conditions and continue allowing people up to age 26 to stay on their parents insurance (in fact one Republican, Marsha Blackburn, even tried to claim that it was Republican who included these in Obamacare.  That’s not the case).   A few Republicans have even started talking about “repairing” the law as opposed to replacing it.

So this is a major shift in philosophy for Republicans, who used to say that it wasn’t the government’s responsibility to make sure people had health insurance or health care.  Whether this is a genuine shift in their beliefs, or just a rhetorical shift, because they know it would be too politically unpopular now to speak the way they used to, is unclear.   Conservative writer Philip Klein believes that GOP philosophy hasn’t really changed, but they’re just too afraid to say honestly that they “don’t believe that it is the job of the federal government to guarantee that everybody has health insurance.”

New Reality + Lofty Promises + GOP Purity = One Big Muddle

And that is why they’re having a hard time coming up with a replacement plan: because 1) it’s impossible for them to reconcile their true beliefs with the promises they’re currently making to the public.  In 2017, with Obamacare fully implemented, Republicans feel they have to promise that everyone who wants insurance will be covered, but that goes against the very core of their worldview.  And on top of that, 2) in order to justify messing with the status quo and repealing & replacing Obamacare, the GOP plan must be even better than what we currently have, so it also must have lower premiums and deductibles and more choices, which is an impossible standard to meet, especially since the GOP – consistent with its true philosophy – will be unwilling to spend more taxpayer money to fund it (as we’ll discuss in the future, they’re going to want to spend a lot less money to fund it, making these promises especially fantastical).

Trump has been particularly expansive with these promises, telling the Washington Post just last month:

We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us. [People covered under the law] can expect to have great health care. It will be in a much simplified form. Much less expensive and much better . . . they’ll be beautifully covered.

So now the GOP have to find a way to offer the American people a plan that will give us health insurance that’s going to somehow be cheaper for customers than Obamacare, but offer us more and better options.  It has to cover everyone with preexisting conditions, and it has to do it without the “dreaded” individual mandate.  And, they have to reconcile all of this with the fact that many of them don’t really believe in any of it.  I probably don’t have to tell you that that’s about as realistic as baking up a chocolate cake that helps you lose weight and gain muscle in all the right places.   And oh yeah, they also still have to deal with – thanks only to themselves & their years of anti-Obamacare propaganda –  a fired up right wing base that’s clamoring for full repeal, period.

So What Now?

So that’s the fix the GOP has gotten themselves into.  Next up we’ll see if they’ve managed to figure themselves a way out of it: a draft House GOP replacement plan leaked on Friday, which to the surprise of almost no one, would make insurance accessible to way fewer people.  And this draft is likely to only be a first offering, which will get less generous as negotiations go forward, since the House’s more conservative wing will fight this tooth and nail.  I hope to talk about what’s in the draft in more detail in another post in the next few days.

But how the GOP will work their way out of this dilemma remains to be seen.  Will they cater to the ultra conservative wing of the Party and end up with an even stingier replacement plan – or worse – no replacement at all?  Will they bow to reality and realize they need to find a way to get Democrats on board?  And would Dems even bite??  Or is there some other way out of this altogether for Republicans??  As you can see, this problem is far, far more complex than Republicans made it out to be all these years.  A lesson they’re belatedly learning.

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Notes:

*And as the articles linked in this paragraph note, Obamcare repeal would affect nearly all Americans, not just those currently insured in the individual market.  Obamacare provides significant protections for people on Medicare and employer sponsored insurance as well.

And this is without even getting into the terrible impact that repeal would have on jobs &  the economy, and on hospital finances (particularly rural hospitals) & uncompensated care costs (ultimately passed on to paying customers) if the replacement plan isn’t well formulated – all things which should offend Republicans’ conservative principles.

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Facepalm Update – 2/27, 12:45pm:  At a meeting this morning with a bipartisan group of governors to discuss numerous topics including Obamacare repeal, Trump told the governors, “Nobody knew that health care could be so complicated.”

I’m pretty sure Democrats actually knew that a long time ago, which is why, after decades of thought on the topic, they spent more than a year drafting an extremely complex bill that has tons of moving parts: many popular parts and some that are not-so popular but necessary for making the popular stuff work.  But it’s understandable why for Republicans, just being attack dogs for seven years and offering absolutely nothing constructive did make it all seem so simple.

Photo Credit: Creative Commons Head in Hands by Alex Proimos is licensed under CC BY-NC 2.0.