July 19th, 2017

The Obamacare repeal/replace collapse: not so fast, Democrats

Democrats couldn’t be happier about the failure and disarray of the Republicans on dealing with Obamacare. But this editorial in Investor’s Business Daily warns them to be careful what they wish for. The title is “Democrats Will Soon Regret That Republicans Failed To Repeal ObamaCare,” and the idea is that Obamacare is failing on its own and Democrats may come to rue the day the Republicans failed to rescue them by reforming it:

It was amusing to hear Senate Minority Leader Chuck Schumer say, after the Senate bill failed, that Republicans should “work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health care system.”

Lower premiums, stabilize insurance markets, improve health care? Wasn’t that what ObamaCare was supposed to do in the first place?

The article goes on to list a host of indications that Obamacare is sinking even further. And then:

…[W]ith repeal-and-replace now off the table, all we have left is the self-destructing ObamaCare. Don’t be surprised if ObamaCare’s popularity suddenly nose-dives again.

So the GOP’s answer to Schumer should be: You had your chance to fix health care. You blew it. Twice. First when you passed ObamaCare, and second when you refused to admit that mistake and decided to cast Republicans as evil. Why should the GOP reward you with a third?

But is “repeal and replace now off the table”? There are rumblings that the “repeal” part is only mostly dead. “There’s a big difference between mostly dead and all dead,” said Billy Crystal in “The Princess Bride,” and it may be true for the repeal effort or even the repeal and replace effort (see this, for example).

Whatever happens to Democrats as a result of the Republicans’ failure to repeal and/or to “fix” Obamacare, there’s little question that at least for now there’s a lot of anger being expressed by the GOP rank and file towards those Republican lawmakers. It’s understandable, and it’s virulent. This isn’t new, however. Contempt for and rage at Congressional Republicans has been widespread on the right as far back as I can remember in my political life since my political change.

One of the many angry things said by people on the right about the Republicans in Congress is that the two parties are the same and that there is no difference between them. But on the contrary, I think it’s actually this way:

It becomes obvious, once again, that Republicans and Democrats are two parties — separate and distinct, with different drive wheels, different motives. They play different games.

Democrats are naturals when it comes to offense; they love to batter down doors and burn down barns to get done those things they have decided for one reason or another need doing, such as the creation of a program of federally subsidized health care.

Republicans by temperament play defense; they hold that line — or fail to hold it — and then fall back to work out terms that might make the situation a little less disagreeable than it was before. Republicans are never entirely unhappy with half a loaf. They think on how much less than half they could have gotten. The notion of wrestling away the whole loaf and digesting it happily in front of the Democrats inspires comparatively few Republicans. They’d rather deal — a preference that comes naturally to the business, front-office types who make the party their home….

The first is short-term. The GOP swore in blood to get rid of Obamacare. It starts to look as if a number of the oath-takers had their fingers crossed behind their backs.

I would quarrel with the phrase “starts to look,” because the Republican rank and file has been feeling for over a decade that every time the GOP members of Congress say they will do something they’ve got “their fingers crossed behind their backs.” The distrust is way up there with distrust of the MSM, and that’s saying something. It wasn’t going to be repaired by something as simple as repealing Obamacare or passing some bill that reformed it and made it more market-friendly. Either of those things probably would have helped a tiny bit, but the praise would have been grudging and much fault would have been found with the details of the thing.

Maybe you think I’m naive and too trusting of the GOP in Congress. I don’t think so, and I’ll tell you why. I don’t feel the same depth of outrage at them for the simple reason that I never invested much trust in them in the first place. I feel that way about politicians in general, and I think the legislative process is inherently slow and difficult and is capable of being derailed by a few dissenters (particularly if the party doesn’t hold an overwhelming majority in the legislature).

Sometime there’s a failure of will on the part of the members of Congress, sometimes a failure of execution, and sometimes both. It’s not always easy to tell which is operating at any given moment. But I’m not naive; I’m cynical.

Is the Obamacare repeal/replace effort over? Maybe for the moment. But I think Congress will return to this problem, sooner or later.

16 Responses to “The Obamacare repeal/replace collapse: not so fast, Democrats”

  1. n.n Says:

    Preserve the status quo with single-payer, though unsustainable that it may; or, restore markets to regulate pricing and availability.

    Unfortunately, the Republicans seem to be trapped in the ball of yarns as much as their Democratic counterparts in a left-right nexus.

  2. Subotai Bahadur Says:

    Obamacare is, for the foreseeable future, the law of the land. It is also fiscally unsupportable. As in it is collapsing financially, and is only temporarily supported by what are unconstitutional transfers of funds started by Obama [funds are not appropriated, and Obama claimed that the statute gave him permanent authority to do so. The Constitution does not allow any appropriation for over two years, nor allow Congress to transfer their power to the president with a statute].

    The lawsuit over the unconstitutional funding is coming to a head. Without that funding it collapses sooner. With that funding, it still collapses but in a year or so.

    Watch the Republican Congress.

    Since Obamacare remains the law of the land; expect the Republican Congress to either drop their suit and support the unconstitutional funding and/or appropriate functionally an unlimited amount to keep it running until the country is bankrupt.

    Give no credence to what they say. They have proved that it means nothing. Watch what they DO, and see if the final result is in any way different from a Democrat victory.

  3. David Aitken Says:

    Looks like Senators Capito and Murkowski are the problem. They voted for repeal in 2015 and are voting against the same bill today. Maybe other Republicans should convince them that they are giving Republicans a bad name.

  4. J.J. Says:

    Gutless wonders! The bill is too mean for two or three Senators, to nice for a few others. Get a clue. There is no perfect bill. They need to take what is possible. Advice to the GOPe: Grow a spine and stay on offense.

    Anything that provides relief to individual policy purchasers is a plus. Enhanced Medicaid is slated, under Obamacare, to end in 2020. Keep it that way and craft whatever changes that are needed over the next three years. Get something passed and plan to do more as the opportunity arises. Health insurance markets will still not be fixed, but in better shape than under Obamacare. Stay on offense. Get things done.

  5. parker Says:

    J.J.,

    Irimi, enter, nage, throw (down) the opponent. Be direct or back down. Too many choose to back down.

  6. Geoffrey Britain Says:

    “the idea is that Obamacare is failing on its own and Democrats may come to rue the day the Republicans failed to rescue them by reforming it”

    Please. If Obamacare collapses (isn’t it too big to fail?) the democrats will blame it all on the Republicans and the mass media will incessantly beat out that meme. Just as they are with Trump and Russian ‘collusion’. Just hide behind the ‘free press’ while never letting up on the Campaign of the Big Lie.

    “hand the people a scapegoat to hate. Let them kill a scapegoat occasionally for cathartic release. The mechanism is ages old. Tyrants used it centuries before the word “psychology” was ever invented. It works, too.” R.A. Heinlein

  7. Matt_SE Says:

    This is hot air on IBD’s part. We have a de-facto two party system; if voters are pissed at one party, where can they go?
    The obvious answer is “the primaries.”
    It’s so obvious, both parties gamed their primary systems long ago.

    I’m not optimistic, but my current plan is to primary the RINOs, then vote 3rd party (non-kooks only) in the event the GOPe wins anyway.

  8. Matt_SE Says:

    Either of those things probably would have helped a tiny bit, but the praise would have been grudging and much fault would have been found with the details of the thing.

    I can’t speak for anybody else, but this isn’t true for me. I hate the GOP establishment with a passion, but if they repealed Obamacare like they promised, that would be enough for me to give them a two-year pass by voting every one of their sorry asses back into office.
    Of course, I would expect new concessions two years after that.

  9. Brian E Says:

    Here’s an interesting factoid. Maine the granite state that Susan Collins represents did not expand Medicaid through the ACA.

    The legislature passed a bill, which was vetoed by the Republican governor.

    So her state wouldn’t be affected by the Senate bill.

  10. Oldflyer Says:

    If the Republican spin machine were competent, and party discipline could be maintained, I believe that the failure of Obamacare could be an albatross hung round the Democrat’s neck.

    The obvious story is that the Democrats forced the failed system on the country, and then refused to participate in any good faith effort to repair it.

    I know that the two qualifications I stated are more fantasy than realistic possibilities, so the risk of failure is high for the GOP.

  11. Brian E Says:

    “Enhanced Medicaid is slated, under Obamacare, to end in 2020.”- J.J.

    I don’t believe that’s the case. The states that took the expanded Medicaid will have to fund 10% of the costs in 2020 as federal funding drops to 90%.

    And couple that with the fact that new enrollees are costing more than existing recipients will but additional budget pressures on state governments.

    A July 2016 report from the Department of Health and Human Services found that Medicaid expansion enrollees cost an average of $6,366 in 2015. The year before, the agency projected enrollees would cost an average of $4,281.

    http://dailysignal.com/2017/03/08/debate-on-obamacare-repeal-centers-on-medicaid-heres-how-states-that-expanded-it-are-doing/

    This is a no win situation for the GOP. The ACA was built on a house of cards that is toppling. The media is going to shift the blame on the Republicans when it does.

    And based on what they have done at this point, Republicans are likely to continue to prop it up– all with borrowed dollars.

    Something that I haven’t seen is any studies that compare health outcomes between states that took the Medicaid expansion and states that didn’t.

  12. Brian E Says:

    According to Brookings Institution expert Stuart Butler, the ACA has largely become the “Medicaid Expansion Act.” This is because less than half as many people have enrolled in the ACA exchanges as expected and Medicaid enrollment has far exceeded expectations in states that adopted the expansion.

    https://www.forbes.com/sites/theapothecary/2016/11/27/new-gruber-study-raises-major-questions-about-obamacares-medicaid-expansion/#52624fea601b

    Republicans lost the first round of persuading the public to reverse the trajectory of the ACA. They need to take a more incremental approach. In my mind there are five distinct elements that should be addressed separately and begin with whichever element the public can be persuaded to support.

    1. The individual mandate
    2. Essential Health Benefits
    3. Medicaid expansion
    4. Pre-existing condition coverage
    5. Taxes to pay for increased benefits

    1. I think liberals have a legitimate argument about the individual mandate. Since we don’t let people die in the streets for lack of health insurance– isn’t the free-rider argument legitimate that people who can afford to purchase insurance should be required to buy it? By mandating that they buy coverage it also reduces the pre-existing condition problem. I know it rankles conservatives to be forced to do anything, but unless we’re willing to let these people suffer the consequences of their foolishness, I think we should require them to take care of themselves.

    2. Essential Health Benefits
    This is one of the elements that added to the cost of insurance. In an effort to level premiums across plans make all plans the same. But I think Republicans win the argument here that it makes no sense to require a 60 year old purchase insurance that covers maternity. I’m not sure this would stabilize the individual market– probably not since the exchanges are failing because so few people signed up. So I would make the penalties stiffer for the individual mandate coupled with less expensive catastrophic insurance plans to entice more Americans to purchase insurance.

    3. Medicaid expansion
    This is one I think Republicans should leave in place for now. By 2020 states are going to have to pay an additional 10% of the cost of the expanded enrollment and you’re going to see states self-limit how they offer coverage. This is an example of it failing under its own weight.

    4. Pre-existing conditions
    This needs to be addressed by a pool that subsidizes people that find themselves facing serious illness during a period they lost coverage. To be eligible though, doesn’t it make sense that at some point in the past they had coverage?

    5. Taxes
    The taxes should remain. The optics of this were so bad, this is one of the first things the Senate bill added back.

  13. TommyJay Says:

    It is interesting that Neo’s post on the Minnesota cop shooting got a bazillion comments and this gets a dozen+. I mean, Federal healthcare/insurance and its future is only going to cost the government trillions more than if nothing had been done, is completely unsustainable, and could bankrupt the nation.

    Neo’s post is terrific. I suspect IBD is engaging in wishful thinking. If we had a hyper rational and honest public discourse via the media, the IBD thesis might have been true; otherwise no, not happening.

    I hope against hope that the pure repeal bill (to take effect at a later date) can be revived from being mostly dead. The passage of Obamacare involved the most horrible sausage making. It is time for Trump and the leadership to ramp up the carrots and outright threats. If they put up the pure repeal for a vote and it fails because of a Collins/Murkowski/Capito no vote, then that can be used against them. Run ads: “they were for it before they were against it.”

    Many blame Rand Paul for the Senate failure, but I think he is a godsend. Today he stated that the entire annual health ins. industry profits before Obamacare was $6B and now it is $15B. He quipped that if the Senate GOPe gets its way, the annual profits will be $30B, and he won’t vote for that level of corruption.

    The Spectator excerpt is great. Dems do offense, but GOPers are more defensive. Too bad the old adage, “The best defense is a good offense is true.”

    Also the part about the GOP being a bunch of business persons trying to cut a deal without a big fight, is apt. Business people must operate and optimize within the limitations of a playing field. But to a large extent, the whole point of politics is to remake the playing field. Dems fundamentally understand this. How is it possible that a major political party fails to understand it??

    No wait! Perhaps they do understand, but the title of Spectator piece is the operative factor. The level of spinelessness and cowardice is the point. Look at this mess with AG Sessions, Rosenstein, and Mueller. Sessions didn’t want to take the heat over Russia so he recuses himself leaving Rosenstein in charge of that. Rosenstein didn’t want to take the heat of the Russia flap and the Comey firing so he appoints Mueller. If Mueller and his lawyer staff are the far leftists I think they are, they will charge into hyper partisan battle with bayonets affixed.

  14. huxley Says:

    It is interesting that Neo’s post on the Minnesota cop shooting got a bazillion comments and this gets a dozen+.

    TommyJay: True.

    However, according to Feedly, my RSS aggregator, this topic is 98x times more popular than neo’s usual topics.

    So apparently many more people are reading this even if commenters aren’t particularly active.

  15. huxley Says:

    Hmm…not sure now. Looks like the Feedly number is based on the number of people who bookmark the web page.

    I guess that’s sort of like popularity but not as satisfying a fit as I would have hoped.

  16. Ymar Sakar Says:

    So instead of anti Trum or pro Trum being right, I was more accurate in my analysis. Why is that not surprising to me.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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