How Republicans lost the health care issue
Democrats have clearly won the health care issue.
Arizona is a key battleground state for control of Congress. We have perhaps the most closely fought race for U.S. Senate. And we have three swing House contests, although Democrats are thought to have the upper hand in all three.
In all of these races, the Democratic candidate is pummeling the Republican nominee over health care, particularly the coverage of pre-existing conditions.
In most cases, the Republican candidate isn’t putting up much of a fight or a defense. Instead, the effort is to change the subject and try to have the election decided on other ground.
This dynamic is being played out throughout the country. Everywhere, Democrats are on the offensive about heath care and Republicans are trying to change the subject.
This is, at least to some degree, an unexpected turn of events.
After the passage of Obamacare – when it became apparent that you couldn’t actually keep your plan or your doctor if you liked them – the health care issue advantaged Republicans.
This was itself an unexpected turn of events. The health care issue had always favored Democrats. Democrats wanted government to give people more of it. Republicans didn’t. For people who voted on the basis of that issue, the nod went to Democrats.
But Obamacare wrecked the individual market for young adults and upper middle-class individuals and families. Before Obamacare, reasonably healthy people in these demographics could purchase reasonably priced health insurance. After Obamacare, they couldn’t.
Obamacare policies are a good deal only for those seriously sick or heavily subsidized. For everyone else, they are a lousy value proposition.
Yet Democrats are winning votes by vowing to protect Obamacare from Republican predations. How did that happen?
Simply put, Republicans fanned their time at bat. Both politically and substantively.
Politically, Republicans failed to repeal and replace Obamacare, as they vowed to do. Political failure is never a strong selling point in a subsequent election.
That failure was partly due to an unwillingness to eliminate the filibuster rule in the Senate. That required negotiating the shoals of the budget reconciliation process, which did not permit a full repeal of Obamacare. In fact, many of the insurance provisions making Obamacare policies a lousy deal for people not already sick or subsidized couldn’t be touched.
Equally responsible was a critical mass of GOP lawmakers who flinched at doing the things necessary to create a well-functioning individual health insurance market. In fact, probably a majority of GOP lawmakers could be so described.
If the United States isn’t to slide into a total government takeover of health care, there has to be a well-functioning individual health insurance market that people regard as an adequate alternative to employer-provided insurance.
There are two elements of Obamacare that render it a lousy value proposition for those not already sick or heavily subsidized. One is the extensive list of benefits that have to be provided, many with no cost-sharing. The other is the requirement to charge all enrollees the same price irrespective of pre-existing conditions.
This buries government-dictated subsidies in increased premiums. A well-functioning individual health insurance market would allow policies to be individually tailored and priced according to actuarial risk.
The sensible option for most people would be to cover routine health care expenses out-of-pocket and take out a catastrophic policy in case something serious arises. Yet Obamacare actually outlawed such policies for those over 30.
The GOP Congress, however, was never really willing to take on Obamacare’s mandated benefits or to allow individual policies to be priced according to actuarial risk. Nor did they fully develop a failsafe government safety net for those with pre-existing conditions who such an individual market might not serve.
And now Republican candidates are getting beat about the head over the need to protect the malfunctioning Obamacare. An argument not made can’t be won.