Republican leaders just can’t seem to help themselves. As they flounder in their assault on the Affordable Care Act, aka Obamacare, they have moved from the inaccurate and counter-factual, beyond partisan buzzwords and talking points, and into a territory where they keep uncorking one howler after another about American health care and the ACA.
- President Trump observed of policy making on the $3-trillion sector that comprises 17.5 percent of the American GDP: “I have to tell you, it’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”
- House Speaker Paul Ryan said in a television interview that Republicans, as they try to repeal and replace the ACA, are “not hatching some bill in a backroom and plopping it on the American people’s front door.” But the GOP then declared its latest ACA draft legislation top secret, and available for viewing only by Republican Energy and Commerce committee members. This led to farcical stunts where a GOP senator, Democratic lawmakers, and members of the media raced around the Capitol, seeking the hidden document in various House rooms.
- Roger Marshall, a Kansas obstetrician who is part of the 16-member GOP Physicians’ Caucus, had this to say about Medicaid, which was expanded under the ACA, covers 70 percent of nursing home residents, and protects the health of as many as 40 percent of the nation’s youngsters, many of them poor: “Just like Jesus said, ‘The poor will always be with us.’ There is a group of people that just don’t want health care and aren’t going to take care of themselves. … I think just morally, spiritually, socially, [some people] just don’t want health care. The Medicaid population, which is [on] a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising.”
- Margot Sanger-Katz, a columnist for the New York Times “Upshot” news feature, cataloged the tortured metaphors and analogies that Republicans have used to characterize Obamacare. These include Georgia freshman Drew Ferguson’s claims that the ACA is like a goat that busted in, then trashed his home. Or U.S. Rep. James Sensenbrenner’s assertion that the act is like a 30,000-piece jigsaw puzzle.
- The GOP discourse on the ACA has sunk so far that Gabby Giffords, a former congresswoman who is recovering from being shot by a deranged constituent, had to tell fearful Republicans like Louis Gohmert of Texas to “have some courage” and to hold town halls on the topic. An Illinois representative had to apologize after saying he wouldn’t attend sessions on Obamacare with voters because they were “out of control,” and the meetings were akin to “the cleansing that the Orientals used to do where you’d put one person out in front and 900 people yell at them.”
The repeal-and-replace ACA policy making, where the president continues to provide little more than platitudes and GOP congressional leaders are recycling unsuccessful approaches, is so upside down now that John Oliver, a British satirist, is making some of the most sense on the issue (see video). He’s raising points I’ve written about (see here, here, here, and here) with wit and laughs. There’s lots of low comedy to be exploited.
Except health care is a life and death matter. Too many Americans have their well-being and finances at grave risk as partisans seek to roll out ideologically based health care experiments, many of which have proven disastrous before. Who, for example, wants to bring back high-risk pools, which Republicans argue would reduce costs for many—but resulted in some Minnesotans paying $18,000 a year in health insurance premiums?
The GOP may decry government intervention and pray for free markets to take care of citizens’ health. But medical debt, a top driver of bankruptcy, is a shameful part of too many lives—especially in the South, a GOP bastion. Obamacare had eased some of this nightmare. The ACA also allowed millions of Americans greater freedom and choice because they did not need to stay with employers to ensure they would have health coverage. Now Obamacare’s repeal may force some older Americans to rethink their retirement plans. It’s also still unclear whether Trumpcare will carry forward the ACA’s initiatives to improve the quality of American health care, and to make it more innovative, as well as evidence-, research-, and science-based.
Here’s also the grim part of how GOP partisans may advance their agenda: The conservative restiveness for action may lead the party to play an abominable game of political chicken, shoving through, over objections of Republicans with any questions, an unformed repeal and replacement of Obamacare just to declare a long desired GOP mission accomplished.
Some of the deepest divides over the Republican attack on the ACA lie within the party itself. Republican governors in states where millions have gotten health coverage when Obamacare expanded Medicaid fear terrible electoral repercussions if voters see their care taken away. Pragmatic party members can do the math and they can see that what’s available on Trumpcare will mean it covers fewer people, costs more, and doesn’t improve the ACA—it will also kick millions off coverage. Some GOP officials are struggling to see why it makes sense to provide tax credits based not on economic need but on age, giving, say, Bill Gates more federal assistance (which he doesn’t need) than a Maryland retiree scraping by just on Social Security. But hard-line ideologues in the party also are steaming that under plans proposed by Ryan and Tom Price, the federal Health and Human Services Department secretary, there will be any tax credits to help Americans get health insurance. They oppose this approach, saying it is exactly what they loathe in Obamacare—which is the federal government taking a role in health care.
The president, Vice President Mike Pence, Price, and Speaker Ryan, according to some reports, may bulldoze any opposition, and hope to enact something in March—even before the nonpartisan, independent Congressional Budget Office can “score” any legislation, telling representatives and the public the measure’s cost and effects. Of course, there’s no Trumpcare bill to scrutinize at this point. Republicans continue to be great rock throwers, crazy talkers, but poor leaders in crafting and executing real, concrete, effective laws and governance to benefit the American people.
Informed voters need to consider how their democratic, legal activism can discourage the GOP from, effectively, holding its middle digit up to the American people, stripping millions from health care, and imposing their unworkable, half-baked ideas to the detriment of us all.