In a speech today before the Catholic Health Association in Washington, President Obama didn’t directly mention the Supreme Court case that could gut subsidies for millions of people in three dozen states on the federal exchange. But he telegraphed the political argument he and Democrats will make in the aftermath of such a Court ruling.
In his speech, Obama made a moral case for the goal of universal health care; an ideological case that government-sponsored health insurance enhances economic opportunity and mobility without setting back American freedom; and a substantive case that the Affordable Care Act is working better than expected. He rattled off a number of anecdotes of people who now have better lives, thanks to the law. But perhaps the most important part of the speech was this one:
“Five years in, what we are talking about is no longer just a law. It’s no longer just a theory. This isn’t even about the Affordable Care Act or Obamacare. This isn’t about myths or rumors that folks try to sustain. There is a reality that people on the ground day to day are experiencing. Their lives are better. This is now part of the fabric of how we care for one another. This is health care in America.…“We’re not gonna go backwards. There’s something deeply cynical about the ceaseless, endless, partisan attempts to roll back progress. I understood folks being skeptical or worried before the law passed and there wasn’t a reality there to examine. But once you see millions of people having health care — once you see that all the bad things that were predicted didn’t happen — you’d think that it would be time to move on. Let’s figure out how to make it better.“It seems so cynical to want to take coverage away from millions of people. To take care away from the people who need it the most. To punish millions with higher costs of care. And unravel what’s now been woven into the fabric of America.”
Translation: Our health care system is now Obamacare. Obama said a variation of this twice. The reference to the “cynicism” of those who want to take coverage away from millions seems like it has an added meaning here: It is misleading of Obamacare opponents to pretend that it can simply be repealed and replaced, not just because repeal would hurt a lot of people; and not just because opponents don’t have an actual consensus replacement plan; but because Obamacare is now our health care system.
Remember, with major health system stakeholders warning of massive disruptions and insurance market meltdowns from a Court decision gutting subsidies, Republicans are working hard to send a message that they’ll be there with a solution to the chaos. Republicans will be there with something or other that will minimize disruptions from that ruling and seamlessly transition us to some new set of GOP reforms. Paul Ryan and other House Republicans are promising an “off-ramp from Obamacare.” Senate Republicans are vowing a “bridge away from Obamacare.” Those things sound so easy, as if all we need to do is glide the car off the ACA’s Highway to Tyranny, and we’ll come to a gentle stop at a nice new health care system that has lower costs, expanded coverage, and of course, a whole lot more freedom.
Republicans are not under any obligation to accept that Obamacare must be forever woven into the fabric of America, or to offer a clean contingency fix plan to the millions who might lose coverage if the Court guts subsidies. However, it is cynical for ACA opponents to refuse to acknowledge the law’s undeniable success in expanding coverage; to pretend that they actually do, or will, have a consensus alternative that would accomplish something comparable; and to vaguely imply that getting to it would be as easy as those “off-ramp” and “bridge” metaphors suggest.
In reality, there is no easy “off ramp” or “bridge away from Obamacare.”