Republicans have settled on a bold, new strategy for not replacing Obamacare. They’re making the moderates in their caucus kill their plan instead of the ultra-conservatives.
And it’s working!
Now this plan might seem strange when Republicans have spent the last seven years acting like Obamacare was the worst thing to happen to the country since the British burned down the White House in 1814. But it’s a little less so if you listen to what their individual members are actually saying.
Some Republicans, you see, are philosophically opposed to the very idea of Obamacare giving health insurance to the poor and sick, while others are only politically opposed to the idea of a president named Obama doing so. If anything, they think that Obamacare doesn’t go far enough to keep deductibles down. Which, as I’ve said before, means that the GOP is stuck in an old Woody Allen joke: It thinks the problem with Obamacare, metaphorically speaking, is that the food is terrible and the portions are too small. Good luck putting those together.
Not that it’s stopped Republicans from trying. The first version of their plan was just a tax cut masquerading as a healt care proposal that still somehow managed to alienate both the center and right wing of their party. It would have slashed taxes by $1 trillion over a decade and paid for that by chopping $839 billion off of Medicaid and $300 billion off of Obamacare’s subsidies, which themselves would have been reconfigured to help the young and affluent at the expense of the old and poor. And it had no chance of passing. That’s because the 24 million people the nonpartisan Congressional Budget Office estimates would have lost coverage as a result were enough to scare off GOP moderates, and the fact that it would have kept all of Obamacare’s protections for the sick in place was enough to tick off the far-right House Freedom Caucus. They think the best way to lower premiums for healthy people is to increase them for sick people.
So they went back to the drawing board. The second edition of their plan was - stop me if you’ve heard this before - just a tax cut masquerading as a health care proposal that still somehow managed to alienate both the center and right wing of their party. The only difference from before is that it would have allowed insurance companies to sell plans that didn’t cover things like mental health, maternity care, prescription drugs and hospitalizations. This still wasn’t enough to get the House Freedom Caucus on board, though, because letting insurance companies sell plans that didn’t cover these “essential benefits” without letting them discriminate against the sick would mean that only the sick would want those benefits - making them unaffordable for everybody.
So they got even more familiar with the drawing board. The latest iteration of their plan is just a tax cut masquerading as a health care proposal - but one that has managed to alienate just the center and not the right wing of the party. Finally, a breakthrough. They were able to do this while keeping the same basic framework - the one that would cost 24 million people their coverage - by saying that states could now opt out of all of Obamacare’s regulations. Insurance companies would once again be allowed to make plans unaffordable for the sick and unusable for the rest. And that might have the added bonus, as the Brookings Institution’s Matthew Fielder points out, of undermining protections against catastrophic costs in not only the individual market but also the employer-based one. This is the liberty the House Freedom Caucus wants.
It’s no surprise, then, that moderate Republicans who didn’t like this bill when it “only” took health insurance away from the old and poor don’t like it any more now that it would take health insurance away from the sick as well. Enough of them are already against it that it almost certainly won’t pass. Which brings us to the GOP’s two fundamental laws of health care. The first is that Republicans can’t get the far right’s support without losing the center right’s - and vice versa - so that no matter what they do, they can’t pass a bill. And the second is that the only Obamacare replacement GOP moderates would support is, yes, Obamacare. If you want people with preexisting conditions to be able to get covered - and they do now - then you either have to have the government do so directly or use a combination of carrots and sticks in the form of subsidies and mandates to get the private sector to. There’s no conservative alternative to Obamacare, in other words, because Obamacare is the conservative alternative.
That’s why it’s only a matter of time until Republicans settle on an even bolder and newer strategy for not replacing Obamacare: admitting that, for many of them, the only real problem with the law was its name.