Many right-wingers — some who decided to champion the ideologically nihilistic President-elect Donald Trump — claim their anger at the GOP’s “establishment” has been fueled by its “betrayal” of the base. In the right-wingers’ telling, they were led to believe that electing a GOP House and Senate majorities would get rid of Obamacare. Aside from a failure to identify any such definitive promise, their narrative makes no sense. Did they really think President Obama would ever sign such a thing? (They could only be betrayed if they had no clue how the legislative process works.)
In any event, they’ve now got a GOP president, House and Senate, so surely they can get rid of Obamacare. That is what the GOP leadership promised over and over again during the election, and continues to do. “Repeal and replace with market-based health-care reform” has been the mantra. In Trump’s words, the replacement will be “something terrific.” Once again, Republicans did not think things through.
They imagined as soon as Obama left the White House, they’d just pull the plug. They were confident Obamacare was never all that popular anyway. Michael Barone, for example, writes that Obamacare was “never firmly established” because it was “passed through slapdash legislation or through questionably legal regulations, [and] never really captured the hearts and minds of the American people.” There is a lot to consider, but let’s focus on four issues.
First, Obamacare sure captured the hearts and minds of the people who went from having no insurance, including those who benefit from expanded Medicaid, to having something. That’s a big deal for those people with preexisting conditions, for non-elderly unemployed Americans and for the working poor. Barone is absolutely right that presidents do better to enact bipartisan legislation if they want it to survive a change in administration. However, with Obamacare established, eliminating it means confronting tangible people, a parade of potential victims. Passing a repeal bill in “slapdash” fashion is actually worse politically than passing it without a full awareness of all the complications. In the case of passage, it just failed to live up to expectations (in part because of unintended consequences); with repeal, the victims will be readily recognizable and truly sympathetic. “Hearts and minds” here will be with the people who most need Obamacare.
Second, the Republicans say that all is well — they have this other thing, namely “repeal and replace with market-based health-care reform.” What’s in it? How’s it going to pass? Who’s going to pay for it? Is it coverage or access to coverage? Is it going to keep expanded Medicaid? While House Speaker Paul D. Ryan (R-Wis.) has the outline of a plan, others have been floating different plans. And no plan has been put to a vote (another huge political failing for Republicans) so there is no guarantee any of them could pass. Moreover, rock-ribbbed conservative and former Pennsylvania senator Rick Santorum pointed out Sunday on CNN that when they “repeal” Obamacare, that eliminates the taxes and fees. “So what they will have to replace it, which means they will have to vote for new taxes, new spending and conservatives are saying whoa, whoa, whoa. We’re not going to do that.” In short, after Obamacare is repealed, people may reasonably conclude they’ll never see the replacement plan.
Third, as Barone noted, Obamacare suffered from a failure to live up to its billing. Republicans are now doing exactly the same as they keep promising to outdo Obamacare. On Sunday, Senate Majority Leader Mitch McConnell (R-Ky.) described some of the problems with Obamacare. “Well, what you need to understand is that there are 25 million Americans who aren’t covered now. If the idea behind Obamacare was to get everyone covered, that’s one of the many failures.” But would a GOP do better, offering coverage — not just access — to those 25 million people? If not, he should not be suggesting the GOP plan will. When he argues that “premiums going up, co-payments going up, deductibles going up,” he is suggesting the Republicans’ plan will reduce the rate of health-care cost increases below those we have seen with Obamacare, but can it?
Finally, Trump’s Rust Belt base may tell pollsters Obamacare is awful. When they hear, however, that Obamacare will disappear, they may very well join with Democrats in vociferously opposing its repeal. Suddenly, there is a super-majority of voters (Democrats, Obamacare recipients, Trump voters) who support keeping Obamacare — and Trump’s voters may be some of the loudest among them. Voters criticize Obamacare, but they will fight to keep it?
Yup, and it wouldn’t be the first time voters’ chosen candidates didn’t correlate with how well the candidate’s agenda served voters’ needs. Especially in a campaign based on visceral, tribal identification and in which Trump refused to offer specifics, one can imagine voters who very much depend on Obamacare casting a vote for Obamacare’s nemesis. They were angry, or felt Trump would look after them, or saw other groups of Americans passing them by economically. (And some just hated Hillary Clinton.) The willingness to buy a slick salesman’s pitch — even one based on the preposterous notion that he “alone” can fix things — defies reason.
Republican leaders may now feel trapped. They promised to repeal Obamacare. How can they not make good on the promise? Actually, they promised to repeal and replace Obamacare. If they ran on repeal and dawdle, they’d have lost. They made their own political trap, first by promising to produce a better, cheaper, more awesome plan out there and then by interpreting the “mandate” as “Get rid of Obamacare fast or voters will kill us!” It defies common sense and ignores the degree to which people have come to depend on it, flawed as it may be. Frankly, repeal and delay sounds like something thought up by the same right-wing groups who talk themselves into radical schemes such as the 2013 shutdown without considering how non-ideological people will view their antics. Look how well that went.
Ryan’s earnestness and fondness for his own white papers do not always serve him well. He should listen carefully to Obamacare recipients, doctors, hospitals and insurers and decide if they really want repeal Obamacare with no concrete replacement. He should listen to House and Senate Republicans who fear Trump will double cross them and vilify repeal and replace once criticism starts rolling in. If they do not think there are 60 votes now to pass a replacement, when will there be? Ryan should stop posturing, put his plan on the table and see if a negotiated alternative based on it can be agreed upon. He needs to replace and then repeal Obamacare.