Saturday, September 23, 2017

Why the GOP Still Hasn't Been Able To Repeal Obamacare

For seven years now, all we've heard from Republicans was how horrible the Affordable Care Act was and how they would do everything possible to repeal it. Occasionally, they would insert the word replace at the end to assuage concerns and to fool people into believing they were desirous of coming up with a genuine replacement. The fact is they never had any interest in a real replacement for the ACA and here's why: there isn't one and they know it.

Think about it: the entire thrust of the GOP argument is that Obamacare was a government takeover of the healthcare system; socialized medicine incarnate. The truth was anything but that. Though flawed, the law requires people who do not get their insurance through their employers to purchase insurance from private providers. If they cannot afford that insurance, they can either qualify for subsidies on exchanges or face a fine for non-compliance.

The winners are people on fixed incomes who have historically been priced out of the insurance market and were therefore relegated to hospital emergency rooms and overcrowded clinics for their healthcare; lower income people who now qualify for the Medicaid expansion provision in the law; and people who had pre-existing conditions that barred them from coverage or had policies with lifetime caps for the treatment of illnesses. The losers are small business owners and people who purchase their insurance on their own. Both saw their rates skyrocket since the law was enacted.

The biggest problem the ACA faces at the moment is stabilizing the exchanges, which everyone agrees are in jeopardy of collapsing altogether. Many insurers are pulling out of markets, leaving people with only one choice for health insurance. The reason for this is because the GOP blocked the funding that was going to insurance providers to compensate them for having to cover people with pre-existing conditions and debilitating diseases. That forced those providers to hike their rates to recover their losses. Simply restoring this funding would go a long way towards stabilizing these exchanges and incentivizing providers to go back into markets they had fled only a couple of years ago.

As for the rest of the problems the law has, a bipartisan approach, like the one Democrat Patty Murray and Republican Lamar Alexander were working on, could've begun to address them and deliver on the promise of affordable healthcare for all. But that effort was put on hold to allow yet another GOP hair-brained scheme to repeal the law; this one coming courtesy of Bill Cassidy and Lindsey Graham. John McCain's decision to vote no on the bill, along with Susan Collins and Rand Paul, who when he watches The Grinch Who Stole Christmas roots for the Grinch, means that this attempt, like the others, will likely fail.

But this failure will not deter the GOP. When you spend the better part of a decade demonizing the signature legislative achievement of your political rival, you've kinda boxed yourself into a corner. In essence, Republicans made a pledge to their base - a pledge that deep down they knew they couldn't fulfill - and now that base is holding them accountable for it.

But here's the thing: that pledge was based on a huge lie. As I started to write above, not only wasn't the Affordable Care Act a socialized takeover of the insurance industry, it was straight out of the conservative playbook, at least according to The Heritage Foundation, which in 1989 wrote a paper on what a healthcare law should look like. That paper became the boiler plate for two landmark pieces of legislation: one in Massachusetts, dubbed Romneycare after Republican governor Mitt Romney, who signed it into law in 2006, and the Affordable Care Act, dubbed Obamacare after Democratic president Barack Obama, who did likewise in 2010.

Both men sought a middle-ground solution to growing healthcare costs that ostensibly kept the private insurance market intact, while mandating that everyone purchase health insurance. The thought was that if everyone bought in, overall rates would go down or at least the rate of increase would slow a bit. It turned out to be the latter, though that slow down only applied to some. Others, as I mentioned before, saw their rates go through the roof.

How and why that happened should concern members of Congress at the moment, not spinning phony propaganda about a law that, had it been proposed by a Republican president, would've been enshrined in the annals of great legislative accomplishments. For those not familiar with the Heritage paper, I encourage you to read it for yourself. While there are some differences between the proposal laid out in the Heritage paper and the ACA, both have enough in common to conclude that far from being a revolutionary hellbent on the destruction of the free enterprise system, Obama was, as his progressive critics have been saying for years, a centrist president who when push came to shove tended to lean more to the right than his Democratic predecessors did.

And yet to listen to most Republicans, Obama was the second coming of Mao Tse Tung. It's sad how far to the right the GOP has drifted over the last twenty-five years. I remember a time when the Grand Old Party had enough room in its ranks for people like Bob Dole and Jacob Javits. Now anyone to the left of Ted Cruz is considered a traitor. I seriously doubt if even Ronald Reagan would be welcomed in today's Republican Party.

And that's why, for all their bombast, Republicans still can't repeal and replace the Affordable Care Act. It's not for lack of trying; it's that every time they come up with a plan, it's so far off the reservation that even governors from Red states end up rejecting it. They all agree they want a healthcare plan that gives people access to affordable insurance; they all agree - or at least most of them do - that those who can't afford to buy insurance, should be given some assistance, be it through tax credits or subsidies; they all agree that the poor or indigent should not have to rely on hospital emergency rooms as a last resort. What they can't wrap their heads around is that they already have a law in place that provides for that, and that law is the by-product of conservative ideals that are decades old.

The Affordable Care Act is not a progressive law, as evidenced by the fact that progressives dislike it almost as much as conservatives. Barack Obama knew that when it passed in 2010. His hope was that the GOP would be reasonable and work with him to improve it. In retrospect, his hope proved to be in vain. And now that he is gone, that same GOP, which had fought so long and hard to undo it, is stuck with it, warts and all.

There is ultimately only one thing they can do if they want to extricate themselves from this nightmare: work with their Democratic counterparts to fix the ACA's flaws. But to do that, they will have to admit to their constituents that they lied to them. Obamacare isn't socialized medicine after all; in fact, it's as conservative as apple pie and Chevrolet. And with a little help from both sides of the political aisle, it could become not only a serviceable law, but one which brings genuine relief to millions without being an undo burden on others.

And that's a goal worth fighting for.

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