Full repeal of PPACA just isn’t politically possible at this point in time.
Here’s something to consider if you’re a disgruntled conservative angry about the Senate’s Obamacare replacement bill: Susan B. Anthony was a vehement opponent of the 15th Amendment. That’s the amendment which reads, “The right of citizens of the United States to vote shall not be denied or abridged by the United States or by any State on account of race, color, or previous condition of servitude.” Why would this genuine icon of feminism (not to be confused with hustlers like Hillary Clinton) object to such a huge leap forward for democracy and justice? She believed it didn’t go far enough.
What has this to do with Obamacare repeal? Anthony’s argument against ratifying the 15th Amendment was identical to that which Senators Ted Cruz, Dean Heller, Ron Johnson, Mike Lee, and Rand Paul are using to justify their refusal to support the Better Care Reconciliation Act of 2017 (BCRA), a draft of which can be found here. Anthony was outraged that the 15th Amendment failed to extend the franchise to women. She was morally right, but politically naïve. If that amendment had included the word “sex,” or “gender” as it would be formulated in our era, it would never have been ratified in 1870.
For those who find the analogy between the 15th Amendment and Obamacare strained, consider that the former passed the House 144 to 44 and the Senate 39 to 13, receiving zero Democrat support in either body. And ratification also encountered enormous resistance. In the end, the amendment was ratified by enough states, but not before being rejected by California, Delaware, Maryland, Kentucky, New Jersey, Oregon, and Tennessee. All of which means that, if Susan B. Anthony had prevailed in her quixotic quest to include women’s suffrage in the 15th Amendment, black men may have waited decades to get the vote.
Likewise, we will be forced to live with Obamacare — in its current dysfunctional form — for decades if headline hounds like “Grandstand Rand” Paul insist on sprinting from one broadcast studio to another braying about insurance for $1 a day and parroting Democrat talking points like the following: “The insurance companies make all the money; all of this is predicated upon still propping up the insurance companies.” Senators Cruz, Heller, Johnson, and Lee are not as irresponsible as Paul, but they tend to resist the reality that politics is the art of the possible. Lee provides an example in his statement on BCRA:
[T]he Senate healthcare bill released yesterday does not repeal Obamacare. It doesn’t even significantly reform American healthcare… It bails out insurance companies. It props up Obamacare through the next election. It lays out plans to slow Medicaid spending beginning in 2025, but that probably won’t happen. And it leaves in place the ham-fisted federal regulations that have driven up family health insurance premiums by 140 percent since Obamacare was implemented. As the bill is currently drafted, I won’t vote for it.
This nonsense suggests that Lee doesn’t get how reconciliation works. He has been in the Senate since 2011, and should know about the Byrd Rule: “The Byrd Rule generally treats as extraneous any provision of a reconciliation measure that doesn’t change the level of spending or revenues, or where the change in spending or revenues is ‘merely incidental’ to the provision’s non-budgetary effects.” Thus, Lee’s kvetching about the failure to eliminate Obamacare’s regulations is naïve. Even less insightful is his claim that BCRA doesn’t significantly reform American healthcare. He clearly doesn’t get its Medicaid provisions.
Obamacare’s Medicaid expansion is a cruel fraud. It perverted the program — at the expense of poor children, the disabled, and the elderly — to cover able-bodied adults whose incomes exceed federal poverty guidelines. And this is no mere inconvenience. Townhall reports that in Illinois alone, “752 Illinoisans on the state’s Medicaid waiting list have died awaiting needed care since the General Assembly voted to accept the Obamacare expansion.” Even if BCRA did nothing but repeal the “reform” law’s Medicaid expansion, and it does, its impact would qualify as far more than “significant.” Here’s Avik Roy on this very point:
The Senate bill includes and refines the best part of the House bill: its reforms of Medicaid.… First, the bill repeals Obamacare’s Medicaid expansion, and replaces it with tax credits so that low-income Americans can buy the coverage of their choice at an affordable price.… Second, the bill gives states a new set of tools to make their Medicaid programs.… Third, the bill puts the legacy Medicaid program on a long-term per-capita cap tied to medical inflation through 2025, and conventional inflation (CPI-U) thereafter.
This third point has been misrepresented by the Democrats in Congress and the media as another “mean” Republican plot to hurt the poor. In fact, the concept of per-capita limits based on GDP, CPI, or some other objective guideline originated with the Clinton administration, but many of the “reporters” writing about BCRA were in diapers when Clinton was President. And has-beens like Nancy Pelosi and Chuck Schumer have no interest in the facts. That reality is what should be the difference between Republicans and Democrats. The former are expected by their constituents to do the right thing to the extent that it is politically feasible.
Which brings us back to Susan B. Anthony and the 15th Amendment. Anthony was in the right and, in the end, her fellow Republicans overcame decades of Democrat obstruction and pushed through a constitutional amendment that removed the barriers to women’s suffrage. However, in 1869, that wasn’t politically feasible. That’s where we are today with Obamacare. Conservatives know that Obamacare should be eradicated root and branch. But full repeal just isn’t politically possible in 2017. So, it’s time to face reality and get rid of as much of this abomination as we can now. AHCA/BCRA isn’t perfect but it’s a damn good start.
Photo: Michael Vadon/Creative Commons