The Atlanta Journal-Constitution
Indifference to health care details backfires on GOP
The collapse of the Republican effort to repeal the Affordable Care Act is a monumental political defeat wrought by a party and a president that never took seriously health care policy or the need to bring coverage to millions of Americans. But their bungling also demonstrates that the intense attention to Obamacare over the last six months has fundamentally altered our nation’s health care debate.
Supporters of the 2010 law cannot rest easy as long as the current Congress remains in office and as long as Donald Trump occupies the White House. Congress can undermine the act through sharp Medicaid cuts in the budget process and other measures. And Trump, placing his own self-esteem and political standing over the health and security of millions of Americans, has threatened to wreck the system.
As long as “repeal Obamacare” was simply a slogan, what the law actually did was largely obscured behind attitudes toward the former president. But the Affordable Care Act’s core provisions were always broadly popular, particularly its protections for Americans with pre-existing conditions and the big increase in the number of insured it achieved. The prospect of losing these benefits moved many of the previously indifferent to resist its repeal.
To the surprise of some on both sides, the debate brought home the popularity of Medicaid, which for the first time received the sort of broad public defense usually reserved for Medicare and Social Security. The big cuts Republicans proposed to the program paradoxically highlighted how it assisted many different parts of the population.
This creates an opening for a push to expand Medicaid under the ACA in the 19 states that have resisted it, which would add 4 million to 5 million to the ranks of the insured.
Republicans also found, as they did during the budget battles of the 1990s, that when they tie their big tax cuts for the wealthy to substantial reductions in benefits for a much broader group of Americans, a large majority will turn on them and their tax proposals.
One Democratic senator told me early on that Republicans would be hurt by their lack of accumulated expertise on health care, since they largely avoided sweating the details in the original Obamacare debate after deciding early to oppose it. This showed.
The popular mobilization against repeal mattered, too. With Republican senators discovering opposition to their party’s ideas in surprising places, pro-ACA activists drove two wedges into the Republican coalition.
One was between ideologues and pragmatic conservatives (Republican governors as well as senators) who worried about the impact of Senate Majority Leader Mitch McConnell’s designs on their states.
The other divide was within Trump’s own constituency, a large share of which believed his pledge to make the system better. They were horrified to learn that they could be much worse off under the GOP proposal. Trump’s approval ratings are dismal, but the GOP plan’s were even worse.
And that is why a scorched-earth approach from the president would be both cruel and self-defeating. Americans now broadly support the basic principles of Obamacare. Republicans, including Trump, would do well to accommodate themselves to this reality.