Senators Rand Paul, Lindsey Graham and John McCain. (photo: Jeff Malet/maletphoto.com)
02 January 14
Prepare for them to search high and low for people disappointed with Obamacare -- then pretend to share their pain.
quick look at the House and Senate vote calendars indicates that
Congress did not in fact come back into session over the holidays to
repeal the Affordable Care Act, which means that as of today (depending
on how you count it) millions and millions of people who were previously
uninsured now have comprehensive healthcare coverage.
There's the 3-or-so million young adults under 26 who
have been covered under their parents plans for a couple of years now,
about 4 million new Medicaid beneficiaries, and some large percentage of
the 2 million who have enrolled in a private plan via Healthcare.gov or
one of 14 state-based insurance exchanges and submitted their first
premium payment.
Their benefits are now active, which means proponents
of repealing the law have a severe entropy problem on their hands. Just
like you can't re-create an erased image by unshaking an Etch-A-Sketch,
you can no longer re-create the pre-Obamacare status quo by repealing
the law. Some new beneficiaries would be returned to the ranks of the
uninsured, just as they were before, but others would return to an
individual market they were happy to leave behind, and even the thin
skim of people who were happy with plans that have been canceled
wouldn't necessarily be able to reclaim them.
After spending three months effusing sympathy for
people who've had their insurance plans canceled, Republicans can't
really continue to support repeal while ignoring the (2 million? 6
million? 9 million?) who would lose their coverage as a result. But the
GOP lacks a consensus replacement for Obamacare, and the plans that
caucuses within the party do support don't do anything for the new
beneficiaries, and fall well short of Obamacare's coverage expansion in
the long run.
They've walked into a cul-de-sac planting mines behind themselves along the way.
Under the circumstances, it'd make a lot of sense for
Republican leaders to seek a New Year's détente. Stop pandering to their
own voters by behaving as if outright repeal is an eventual
possibility; stop fogging things up for their own constituents, many of
whom would be better off if they understood what the law has to offer
them. Democrats want to fix flaws in the Affordable Care Act,
Republicans could agree to support some improvements in exchange for
making the law system more GOP-friendly without undermining its
structure.
But in the least shocking news you'll hear all year,
Republicans lack both the intent and ability to adopt a less combative
approach to healthcare reform. They like how the last three months of
2013 unfolded politically (a three week government shutdown
notwithstanding!) and will do whatever they can to make 2014 look a lot
like that. They'll probably even fund the government and increase the
debt limit without inviting crises to keep the media focused on
Obamacare.
This week they will begin exploiting for political
gain the misfortunes of people who seek medical care under the
impression that they're covered only to find out, for some reason, that
they're not. These might be beneficiaries who, due to technical woes and
clerical backlogs, are having trouble accessing their benefits, or
people who thought they had enrolled but never actually did.
When someone finds he's eligible for fewer subsidies
than he believed, conservatives will pretend to share his outrage; when a
family earns more money than expected and must rebate subsidy dollars
to the IRS (a clawback provision Republicans supported!) the GOP will be
there.
Don't believe me? Here's Sen. Lindsey Graham, R-S.C., quoted in the New York Times.
"The hardest problem for us is what to do next," Graham said.
"Should we just get out of the way and point out horror stories? Should
we come up with a mini Contract With America on health care, or just
say generally if you give us the Congress, the House and the Senate in
2014, here's what we will do for you on multiple issues including health
care? You become a more effective critic when you say, 'Here's what I'm
for,' and we're not there yet. So there's our struggle."
According to the Times, "Mr. Graham said that
Republicans would probably get away with denouncing the Affordable Care
Act through the midterm elections, but that by 2016 they would need to
have a fully formed alternative."
The Democratic response to these stories will take the
form of aggregates as much as discrete stories. Some of Obamacare's
"winners" will win with lifesaving surgery or chronic care. But most
will just benefit with access to routine care. "Area Man Gets First
Colonoscopy" isn't a great counterpoint to "Area Man Can No Longer See
Same Doctor."
So Democrats will also brandish a growing beneficiary
total. By the end of March, that figure will probably exceed 10 million.
Millions more, even the law's greatest skeptics, will know people whose
lives are better as a result of Obamacare. If they're smart, supporters
will organize devoted beneficiaries and their families so that
Republican candidates begin to fear attacking the law, and Democratic
candidates regain confidence in their ability to run on a platform of
keeping and improving it.
By spring, we should have a clearer sense of how these
conflicting constituencies stack against each other, and, thus, how the
political story will play out. But until then I expect inertia will
prevail on the right. They'll continue to pretend that new beneficiaries
don't exist and to solicit horror stories as if the calendar still said
2013, and will do so for as long as they sense it's to their political
advantage.
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