The Washington PostDemocracy Dies in Darkness

Opinion Susan Collins and Republicans better have better answers on Obamacare

Sen. Susan Collins (R-Maine) on Capitol Hill in Washington on Oct. 5. (Melina Mara/The Washington Post)

Republicans ran in 2018 insisting they were committed to protecting people with preexisting conditions from being priced out of the health-insurance market. However, when a district court judge last week in Texas struck down the entire Affordable Care Act, including the protection for preexisting conditions, Trump celebrated:

Other Republicans, however, looked somewhere between uncomfortable and mortified by the result. None has more reason to be squeamish than Sen. Susan Collins (R-Maine), who voted to strip out the individual mandate in the tax bill, providing the basis for Republican governors to sue and strike down (temporarily) Obamacare. Her performance on the talk shows was cringeworthy. On ABC’s “This Week” with George Stephanopoulos, she insisted she had no regrets:

STEPHANOPOULOS: Let's talk about health care. You heard Senator Durbin say that this judge's ruling is a real problem for Republicans now. What's your reaction to the judge's ruling?
COLLINS: The judge's ruling was far too sweeping. He could have taken a much more surgical approach and just struck down the individual mandate and kept the rest of the law intact. I believe that it will be overturned.
STEPHANOPOULOS: You say it’s going to be overturned. He based his ruling, as you said, on last year's tax bill which brought the tax penalty for violating that mandate down to zero and then he said that invalidated the whole law. Any second thoughts on your vote for that bill because of this?
COLLINS: Not at all. I think it's important to keep in mind what the impact of the individual mandate was. Eighty percent of those who paid the penalty under the individual mandate earned less than $50,000 a year. So this disproportionately affected lower and middle income families. In addition, not one Democratic senator offered an amendment to strike the repeal of the individual mandate, although they had the opportunity to do so.
And that’s because it was probably the most unpopular and unfair provision of the Affordable Care Act. There are many good provisions of the law. Those should be retained.


At Arlington National Cemetery on Dec. 15, President Trump opined on the federal judge's ruling that the Affordable Care Act is unconstitutional. (Video: The Washington Post)

Collins, of course, got an empty promise on other means to reduce health-care costs, but she really has no good defense for her vote eliminating the individual mandate without anything in its place. On CNN’s “State of the Union” with Jake Tapper, she again struggled to explain herself:

TAPPER: So, millions of Americans, including everyone covered by Medicaid expansion and many with preexisting conditions, are going to lose their health insurance if this ruling is upheld. 
You voted for the repeal of the individual mandate as part of the tax reform bill last December. That’s the basis of this judge’s decision. You heard President Trump call this — quote — “a great ruling for our country.”
Do you agree? 
COLLINS: I don’t. 
First of all, I would probably any doubt that this ruling is not going to affect people who are currently enrolled or in Obamacare policies, so — or their policies for 2019. 
There is widespread support for protecting people with preexisting conditions. There’s also widespread opposition to the individual mandate. And here’s why. The individual mandate penalties, 80 percent were paid by people — 80 percent of the people who paid the penalty earned under $50,000 a year.
So, this hurt low- and middle-income families who couldn't afford the cost of health insurance. And it's telling that, when the tax bill was on the floor, not a single Democratic senator offered an amendment to strike the repeal of the individual mandate. That's how unpopular it was.
I think this will be overturned on appeal.
TAPPER: You do?
TAPPER: In the Supreme Court or in the 5th Circuit, or — or where do you think it ...
COLLINS: I’m not sure where will occur, but there’s no reason why the individual mandate provision can’t be struck down and keep all of the good provisions of the Affordable Care Act, such as coverage for people with preexisting conditions, the mandated benefits for substance abuse and mental illness treatment, and also allowing young people to stay on their parents' policies until age 26.

The reason it very well might be eliminated is because her party’s governors brought the lawsuit, her party’s lawmakers never had an adequate replacement for Obamacare and the president, who is in her party, has attempted to undermine and disable the law. (It will be interesting to see how the Supreme Court justices she voted to confirm will decide, if and when it reaches the court.) She’s making a great case that if Mainers want Obamacare or some variation thereof, they will need a Democratic Senate and president. (She didn’t help her reputation as an “independent” voice or promote her reelection by claiming not to have enough knowledge to comment on Trump’s hush payments to women. Really? Tapper sounded incredulous.)

On “Meet the Press,” Sen. Roy Blunt (R-Mo.) didn’t fare any better.

CHUCK TODD: But didn’t this federal judge act like a legislator? And he decided, on his own, what the law is going to be? Isn’t this a form of judicial activism? He said, “Well, I’ve decided that Congress said this is a zero tax. I’ve decided it’s no longer a tax.” That’s the definition of a judge writing legislation, is it not?
BLUNT: That doesn’t mean, that doesn’t mean that legislators can act like judges, just because, just because judges sometimes act like legislators.
TODD: So you acknowledge, in this case —
TODD: — the judge has probably overstepped his bounds here?
BLUNT: You know, I think the, the thing to remember about the judge’s ruling is it has no immediate impact. There — nothing changes yesterday. Nothing changes tomorrow. This’ll have to go through a circuit court process. Who knows if the circuit court would uphold it or not. That will either be quickly dismissed, which is one option, or a long period of time, in my view, before the circuit court deals with it. This will be another area where — this — health care will be used as a political issue way beyond the ramifications of one district judge making a ruling that has no immediate impact.
TODD: Well, let me tell you what the president said. The president said this was “great news for America." That was his point. Do you agree with him?
BLUNT: I think it’s basically just, for America, it means we’re going to continue to debate this. Health care clearly matters to people. Some of, you know, what we had with Obamacare, as you’ve already called it today, was a, a poorly thought-out plan, really poorly, poorly implemented to start with, that’s had lots of negative impact on lots of families, who have insurance they don’t need with deductibles they can’t afford. We need to be —
TODD: Let me pause you there. If all of that is true, why have you guys failed to be able to come up with an alternative? You’ve had eight years, as a party, to come up with some alternative —
BLUNT: Well —
TODD: — that can pass.
BLUNT: We’ve had lots of alternatives. We had lots of alternatives when Obamacare passed. You know, the adding, letting children, people up until age 26 stay on their parents' insurance was a bill I filed. As far as I know, it’s the only, only Republican proposal that was filed during that process as an independent bill. It was four pages. And it probably insured more people than any other single part of the Affordable Care Act did. There were lots of ideas out there. It’s just the other side didn’t want to listen to those ideas.
TODD: But in fairness, your party can’t unite on any idea, though. I mean isn’t that, if you had one —
BLUNT: Well —
TODD: — wouldn’t you have a — more leverage at the table?
BLUNT: I, I wouldn’t say we couldn’t unite on any idea. But this is a very difficult issue and a closely divided Senate. You know, 49 senators, including me, voted to do something last year that a, that a couple of Republican senators couldn’t agree with. Trying to get — this is why the committee process matters. You know, the one thing I think we would be able to unite on is Medicare-for-all would wind up meaning Medicare for none. If Democrats want to take that view to the American people, and seniors, particularly, people who are now covered by Medicare, understand the ramifications of that. There is no way that will happen. And there’s no way voters will let it happen
TODD: Was this lawsuit necessary?
BLUNT: You know, I’m, I’m not in the job of questioning what state attorney generals decide they want to do.

Yikes. There’s a guy who needs an appellate court to reverse the ruling — as quickly as possible — to get him and his party out of this bind.

Republicans are the proverbial dog who caught the bus. They are to blame if the law, with no alternative, is not revived by a higher court; they are to blame if either by litigation or administrative action those with preexisting conditions are priced out of the market.

We just had an election that turned on this precise issue. Democrats overwhelmingly carried the day by accusing Republicans of seeking to sabotage protection for preexisting conditions. Now that Collins, Blunt and others have made a mess, it is up to them to fix it — or face the wrath of the voters in 2020.