Here’s a question: How long have Republicans been running for federal office on repealing Obamacare, in Senate Majority Leader Mitch McConnell’s terminology, “Root and branch”?
Answer: since 2010.
Outside of the 2012 election, which was a clear outlier influenced by a number of factors which had nothing to do with healthcare policy, the 2010-2016 period in American elections has been a stunning success for the GOP. The party went from a 59-41 deficit in the Senate to a 55-45 majority, which is now still a 52-48 majority, it went from Nancy Pelosi as Speaker of the House to John Boehner and now Paul Ryan, with a comfortable House majority that shows little sign of abating any time soon (there was talk not long ago about the Democrats retaking the House in 2018; after the Jon Ossoff debacle and related losses in congressional special elections this year you don’t hear much of that anymore), Republicans have made colossal gains in governor’s mansions and the Democrats have lost some 1,000 state legislative seats.
That’s what the last seven years have wrought for the Party of Obamacare when the only coherent message the GOP has mustered was the complete repeal of the Democrats’ signature legislative achievement in the past generation.
You would figure that with Donald Trump in the White House and Republican majorities in the House and Senate, repealing Obamacare would be a no-brainer.
OK, the repeal-and-replace angle could be harder to pull off. That’s understandable. There are lots of different kinds of Republicans, and it might be hard to get all of them to coalesce behind a single federal healthcare policy to replace it. Those of us whose studies of the American public sector have led to an understanding that the less federal healthcare policy there is the healthier the healthcare industry will be have a far simpler solution to that problem, but we are unfortunately not the majority — in the House, Senate or public. That’s a shame, and it’s a symptom of a larger civic disease, but that’s for another column in this space. There will be a replacement for Obamacare, and we can hope it’s less awful than what it stands in for.
But when the Senate version of an Obamacare replacement foundered and McConnell announced the next step would be, early next week, an up-or-down vote for an Obamacare repeal now and the crafting of a replacement as a consensus for one emerges, that’s something an entire GOP caucus can vote for.
Minus Susan Collins, of course; Maine’s quote-unquote Republican Senator wouldn’t vote to repeal Obamacare back in 2015 when McConnell’s majority sent a bill doing just that to then-President Obama’s desk to die. But outside of Collins and Mark Kirk of Illinois, who is no longer in the Senate, the rest of the caucus was on board with the repeal.
And yet Alaska’s Lisa Murkowski, West Virginia’s Shelley Moore Capito, and Ohio’s Rob Portman have now joined Collins in announcing they won’t support a repeal when the vote comes up next week.
What is wrong with these people?
Capito laced her announcement with a special bit of arsenic for Republican voters. “I didn’t come to Washington to hurt people,” she said.
No, Senator, apparently you came to Washington to lie to people.
It is not acceptable to have voted for repeal when there was no chance of that repeal to become policy, and then to oppose repeal when it will become policy. That’s what’s known as a lie, and it’s a disgrace.
McConnell doesn’t have to announce publicly what the consequences for such a betrayal might be, as his job now is to back Murkowski, Portman, and Capito off their public stances and get their votes. If that means a new Bridge to Nowhere connecting Gustavus and Pleasant Island, or a new airport servicing Chillicothe, or an I-77 loop around greater Parkersburg, then maybe that’s a small price to pay to make this happen. Or in the alternative, it’s not necessary for us to know what threats are made — a guaranteed primary opponent, a cutoff of NRSC funds, a negative change in committee assignments, or a new office in what used to be a broom closet in the Dirksen Building — to keep these people on the straight and narrow.
But the idea McConnell can’t deliver votes for a policy that he could deliver for preening simply will not cut the mustard.
Particularly given the dynamics of the legislation at hand.
Why can’t the Republicans get to 50 votes for an Obamacare replacement? Simple — the Democrats, to a man, refuse to vote for any change at all. And why? Because they want the status quo. That’s understandable, after all; take away Obamacare, and there will be absolutely nothing to show for the eight years Barack Obama spent in the White House — or the sacrifices that party made down the ballot for his time as president. When Obamacare goes, it’s all for nothing. But get rid of that status quo and their incentives flip over — with 25 of them up for re-election next year they’re going to have to have something to show for their time or else the pressure will be on them back home, and a few of them (Joe Manchin, Heidi Heitkamp) might suddenly turn into honest legislators. Why Portman, Murkowski, and Capito can’t see that is beyond your author’s understanding.
And Obamacare will go, by the way. The market is killing Obamacare deader than Elvis. That you can bank on. By the end of this year there will be 1,400 of the nation’s 3,007 counties serviced by one insurer… or none. More than 80 insurers have left the Obamacare exchanges since they were created. Eight million Americans paid more than $3 billion in fines for refusing to buy Obamacare insurance last year. All of these numbers are getting worse.
Virtually all the growth in the number of insured under Obamacare has come courtesy of the expansion of Medicaid. Medicaid has been described by Sen. Bill Cassidy (R-Louisiana), who happens to be a doctor who treats Medicaid patients, as “the illusion of insurance.” Cassidy terms it that because just because you might be covered by Medicaid it doesn’t mean there will be a doctor who will see you. Not with the awful reimbursement rates Medicaid pays. As a result, an Oregon study found that healthcare outcomes from Medicaid enrollment are no better than being uninsured, and multiple studies have shown increased Medicaid enrollment leads to more abuse of emergency rooms rather than less. So much for Medicaid’s cost savings. It might be the signature waste of taxpayer money in the whole federal budget.
But back to Capito’s sound bite about not wanting to hurt people — tell that to the tens of millions of Americans stuck paying higher premiums so as to be covered for things they will never need coverage for, and tell them they really didn’t need new school clothes for the kids or a new air conditioner for the house or a replacement TV for the old one which has given out, because they’re paying through the nose on a health insurance policy with a $6,000 deductible. Tell them they can’t get relief for that burden because Capito doesn’t want to hurt people.
And then there’s the Congressional Budget Office, which like a rooster atop a pile of horse manure crowed this week that a straight repeal would put some “32 million Americans” out of their health insurance by 2026, as though over the next 10 years the market wouldn’t create insurance products to service some 10 percent of the public who are soon-to-be free agent customers. Anyone who believes CBO analysis is a fool — sure, they might be “bipartisan,” but that hardly makes them credible. When was the last CBO projection that turned out to be accurate?
By the way, any change from Obamacare will automatically be scored as putting 20 million Americans out of their health insurance. Why? Because CBO assumes 15 million Americans will forego enrolling in Obamacare insurance policies if they’re not mandated to do so and that five million Americans won’t go on Medicaid in states that have not expanded it yet. CBO is assuming that eventually, every state will expand Medicaid if Obamacare is not repealed and the non-expansion states have five million future Medicaid enrollees in them.
What’s more, within the 15 million CBO includes four million people who already signed up for the Medicaid expansion. CBO believes that if the mandate goes away four million people who are on a free insurance program will opt not to have health insurance. That’s how popular Medicaid is, and how valuable it is to its enrollees.
CBO also thinks there will be 18 million people enrolled in Obamacare in 2018. In reality the number will be half that. It’s that quality of analysis which asserts that a market suddenly free to offer cheap, catastrophic health coverage not burdened by having to cover male pregnancies or female prostate cancer can’t effectively attract customers.
And yet Shelley Moore Capito thinks if this status quo isn’t ripped away and the ground is prepared for something better, she’ll be “hurting people.”
Apparently, there’s no IQ test to be a Senator. We already knew that; after all, Kamala Harris and Dick Blumenthal are Senators, and so is Al Franken. What stinks is those might not be the dimmest bulbs in the body after all.