Alternate Title: The ACA has taken center stage, and it’s a Yuge problem for the GOP.
I have never claimed the Affordable Care Act (ACA) is perfect. I have always pointed out its flaws and ways to improve it. What I also pointed out is that the ACA was bigger than its parts, that it created a mindset that would be impossible to repeal – A mindset that says, “Health care is a right, and everyone deserves it.” That’s. Important. And it’s not going away.
Republicans are facing that mindset. They are starting to squirm. Last week I wrote about how cheap campaign rhetoric makes for impossible governing:
Governing is hard, guys – especially when your plans will result in people losing their health insurance and preexisting conditions are no longer covered. Hope all that over-the-top rhetoric was worth where you find yourself now.
Well, it’s no longer campaign rhetoric. It’s no longer an easy, cheap way to fire up your base who doesn’t understand how the ACA functions. It’s time to walk your talk – and boy, did you talk over the last 8 years. You talked so much that your supporters stormed the castle with pitchforks in hand. Guess who lives in the castle now.
The thorniest issue is with preexisting conditions. Everyone agrees that people with preexisting conditions should be covered by insurance. (Okay, probably not everyone. There are monsters among us.) That’s where the biggest expense for insurers comes from. Good luck making repeal and replace work without addressing preexisting conditions and how they’re paid for.
TPM has a post up titled: Five Points On Where The Obamacare Repeal Saga Stands Right Now. It’s worth your time to read in its entirety. Please notice, these points (problems) don’t even touch on the most difficult part of how to replace the ACA. This article only addresses the problems of repeal.
Here are the 5 points:
- Should repeal come before replacement?
This strikes me as a ridiculous question. Of course, repeal and replacement need to happen at the same time. Republicans know this, but they’ve boxed themselves in. They have to repeal Obamacare – it probably, given all their talk, has to be one of the first things they do. There’s no way around this. Add to this that they have no replacement plan – at least not one that doesn’t result in millions of people losing their health insurance, which they are now on record promising that that won’t happen – and we can see the walls closing in. Those promises are going to be difficult, if not impossible, to keep.
2. Should repeal help pay for a replacement?
Oh what a tangled web we weave.
From the article: “The Obamacare repeal bill passed by Congress and vetoed last year by President Obama immediately repealed taxes that have helped pay for the program. If the new repeal effort eliminates those revenue sources immediately, paying for the replacement plan become politically very difficult.
Some Republicans have acknowledged that a replacing Obamacare will be costly, and the political hurdles to re-raising taxes after the ACA’s revenue boosters are dismantled is high.
“There are a lot of conversations going on about whether to hold on to some of that to fund appropriate replacements or not, and what the right timing frame is to set for that replacement to be in place,” Sen. Roy Blunt (R-MO) said on Capitol Hill Thursday.
Among the options being considered is delaying Obamacare taxes for the phase-out period, rather than repealing them entirely, so they’ll be available to fund an ACA alternative. Additionally, the Senate bill that will act as a vehicle for repeal lays the groundwork for a reserve fund to capture the money that would be saved by dismantling some aspects of Obamacare.”
So… they want/need to keep those tax dollars to fund their replacement? They need tax dollars for their plan? How many of their supporters get this? Not many, would be my guess. I swear, at the rate they’re going they’ll keep everything in the ACA the same and simply call it Trumpcare and FCA (Freedom Care Act). It’s scary how I can see that happening.
3. Should insurers be “bailed out” to stabilize the post-repeal marketplace?
LOL! Is this really a debate? Of course, they’ll bail out insurers. They’ll have to if they stick with repeal without replace.
This is the problem that comes when you choose rhetoric over substance – when you wear only your campaign hat instead of your thinking cap.
From the article: “GOP lawmakers are promising a stable transition, but facing an irony that the sort of provisions that would incentivize insurers to stay in the individual market while a replacement is put together are similar to ACA measures they railed against in the Obama era.
Some Republicans are admitting that they’ll have to temporarily put their disgust with so-called “insurer bailouts” on hold to smooth the dismantling of Obamacare, while others worry that may make them look like hypocrites or are even expressing a frustration that they would need to help insurers at all.”
Hypocrites? Ya think?
4. Should repeal defund Planned Parenthood?
This is another instance of campaign rhetoric coming back to haunt the GOP. My first reaction to this question was, “Duh, of course they’ll defund PP. That promise is right up there with repealing Obamacare!”
But there are more cracks within the party.
From the article: “Though Senate Republicans were able to muster up the votes to pass the defund Planned Parenthood provision when it was part of the 2015 repeal bill, it’s proven to be a thorny issue for some GOP lawmakers. Collins has opposed the measure, and Sen. Lisa Murkowski (R-AK), who supported the 2015 bill, voted against defunding Planned Parenthood in other legislation.”
Seems like the GOP can always “muster up” votes when they won’t count and are for show – it’s quite another story when they actually have to govern.
5. Should Medicaid expansion be repealed?
It’s like the GOP thinks no one has ever listened to what they say. Like defunding Planned Parenthood, why is this even a question? They’ve been clear in their “waste, fraud and abuse” position when it comes to Medicaid. But, here we are.
From the article: “The 2015 House repeal bill did away with the federal funding for Medicaid expansion after two years. And in interviews with TPM, it is clear that Republicans from states like West Virginia and Ohio –where Medicaid expansion had drastically lowered the uninsured rate– have an interest in protecting it.”
In other words, expanding Medicaid worked – and it worked for *gasp* white people. West Virginia (according to the census) is 93.6% white. Ohio is 82.7% white. Guess who will be hurt the most in these states should the Medicaid expansion be repealed?
Here’s the deal, there are going to be a lot of uninsured Trump supporters if Republicans do what they were flippin’ elected to do. I’m trying to “muster up” sympathy, but I’m having trouble generating that emotion. It’s a shame that so many Trump supporters didn’t consider their own situations when voting against those other people getting stuff. They are in for a rude awakening.
I’m not sure how everything on this list will come about, but my money’s on defunding Planned Parenthood and the Medicaid expansion happening, because, you know… women and poor people.
Note to elected Dems: DO NOT ASSIST WITH THIS NONSENSE. This is a Republican mess. Add your support and it becomes ours as well. Just… No.
@ Pandora How is this a Republican mess, when the Dems implemented this mess. Way to pass the buck and not take ownership!! Typical!!! There was a great deal of money wasted on the ACA! It needs to be changed, NOW. This was pushed through on all!
I think the GOP has gotten itself backed into a corner, true. But I don’t think that your picture of the corner, while accurate, is “truthy” enough. There are two things going on here–(1) Trump’s people haven’t yet managed to get the new GOP in Congress into lockstep (but I think in at least the short run they will); and (2) Steve Bannon hasn’t told Trump what he thinks about ACA Repeal/Replace yet because what they’re really doing is testing memes.
And here are the memes they are testing–
(1) The ACA has placed a crushing burden on too many Americans, and has actually stripped health insurance away from many citizens by raising their premiums and deductibles to the point where people who used to have good insurance (the people who were promised that they could keep their doctors) now are being beggared to pay for shitty insurance. If you avoid numbers, you can make that sound good.
(2) We’ve tried for the past 6 years to work with the Democrats who passed this flawed bill without any GOP votes to fix it. They didn’t want to fix it, they wanted to pretend it’s perfect. Now the voters have hired us to fix their mess. We’d still like them to be part of the solution, but if they don’t want to be, we’ll do our job.
(3) Benghazi! (Just wanted to see if you were still reading.)
(4) We have to fix Obamacare despite the inevitable disruptions caused by the Democrats poor planning, because as it stands now the insurance companies are facing bankruptcy, businesses are being asked to shoulder an unfair burden, and our citizens who can least afford it are being hit with gigantic tax penalties. If we don’t fix this the same way Ronald Reagan had to fix the economy in the early 1980s (after similar Democrat ineptitude), then we are in for more recessions, more job losses, less American greatness. Yes, it will be tough for the next few years on some people, but the right medicine doesn’t always taste good.
(5) The UK National Health Service is collapsing. As recent media accounts prove, their hospitals are in a state of humanitarian crisis. This is where socialized health care inevitably leads–to people dying in hospital beds because the death panels said they could have no medicine. We can’t afford to let that happen to our parents and our kids. Only free enterprise can save health insurance in America.
The media will normalize this by treating it as a rational set of views, and when they roll out the American Free Enterprise Health Care System our current crop of Democrats will never see the speeding truck that hits them
Well, thanks for the scary bedtime story, Steve!
So we’re back to more Republican lies? I’m not sure that will work because:
1. The Rs don’t need the Ds to pass anything. Rs will be fighting Rs. How do you blame Dems after you’ve been crowing about winning everything? It’s their show to run. And there’s no way you can pass parts of your agenda easily (tax cuts for the rich) and then whine that you can’t do anything when it comes to health care/insurance. Either they make everything a struggle, or they expose the splits among themselves.
2. No way a cancer patient, or parents with a sick child, etc. are going to be okay viewing their lost insurance as the right medicine. One chemo treatment can run up to 10,000.00. No one will accept that bill in the name of the greater good
3. The white working class voted to “punish” other people – Trump painted his villains quite clearly. They are supposed to be great again under President Trump. They are not the ones who are supposed to suffer.
4. While DE turned the ACA into a hostage situation, many states did not – a lot of those states are really red and really white. They are also really poor so they’ll be doubly hit when the GOP hits Medicaid. Again, Trump made promises to these “forgotten and ignored” people.
5. There is no way to eliminate the mandate and keep all the goodies people really, really like
6. And no one has an ounce of sympathy for insurance companies, so I’m not seeing the GOP putting them forth as victims
The Republicans own their rhetoric. Spinning a tax cut is one thing. Spinning denying a sick child is quite another.
If have as much right to health care as you can afford, your “right” is just a privilege.