I hesitate to call any part of the Republican Party “pragmatic,” but apparently some of them have some sense that the entire American public might not see things the way they do.
So over the past several days I’ve seen news stories saying some congressional leaders want to keep some parts of Obamacare. The fix they are in is that some parts of the ACA are now in effect, and most of those parts have proved to be popular.
For example, 2.5 million young adults are now insured on their parents health care plan who couldn’t get insurance before. To date, the ACA has said Medicare recipients $3.5 billion on prescription drugs. Several hundred thousand seniors have taken advantage of the various free preventive care screenings now available to them. This summer $1.3 billion in rebate checks are going out to people who were overcharged for their insurance.
On top of that, if the Supremes strike down the ACA this summer, the Medicare system could be thrown into chaos, at least temporarily.
So, over the past few days I’ve seen several news stories saying that some congressional Republicans are planning to keep the “good” Obamacare bits. In particular, they want to keep the provision that allows children to stay on their parents’ insurance until age 26; they want to eliminate the prescription drug doughnut hole; and they want to provide that insurance companies have to insure people with pre-existing conditions.
However, as soon as one of these stories comes out, another story comes out saying that other congressional leaders demand complete and unconditional repeal. No walkbacks. John Boehner seems to take both positions, on alternate days.
At TPM, Sahil Kapur writes that Republicans are being warned not to go wobbly on Obamacare.
FreedomWorks and Club for Growth, two powerful conservative interest groups that are fresh off of purging the Senateâ€™s longest-serving Republican for insufficient fealty to the right, are flexing their muscles.
â€œThe Club for Growth supports complete repeal of Obamacare. And complete doesnâ€™t mean partial. It means complete,â€ said Barney Keller, a spokesman for the group. â€œWe urge the so-called â€˜tea partyâ€™ Republicans to keep their promises to voters and continue to fight for complete repeal as well.â€
The “pragmatists,” relatively speaking, want to have a fallback position in case the ACA is entirely overturned and the benefits people had begun to enjoy from it dry up. They want to be able to say to voters that they can still have their 20-something children on their health care benefits and that the doughnut hole can still be closed.
As for insurance for pre-existing conditions, there is no way the private insurance industry can do that without the individual mandate, a complication that Republicans refuse to address. But the ideological purists don’t want to promise anything.
Dean Clancy, who leads health care advocacy for FreedomWorks, said the group â€œwould be very concerned about bills to resurrect parts of Obamacare.â€
He said Republicans should take no responsibility for the broken system that would result.
â€œIt would be the height of folly for Republicans to say, OK, this is our problem now,â€ he said. â€œItâ€™s not the Republicansâ€™ fault if 25-year-old slackers suddenly are dropped from mom and dadâ€™s health insurance policy. Itâ€™s not the Republicansâ€™ fault if various other provisions of Obamacare are no longer on the books. â€¦ The American people need to have a chance to reflect on the fact that the Democrats basically rammed an unconstitutional bill down their throat.â€
We could quibble about who is ramming what, and where.
A few days ago Jonathan Chait recalled that Republicans promised a comprehensive health care reform plan in 1993, when they defeated “Hillarycare.”
In 1993, Bill Clinton tried to reform health care, and it appeared a strong enough threat that Republicans devised their own plan in response. It was a great way to send the message â€œwe have a plan, too.â€ When Clintonâ€™s plan collapsed, he made feelers toward the GOP plan, but Republicans turned against it, promising instead to start over in the next Congress.
For the next sixteen years, Republicans did zero to advance the cause of comprehensive health-care reform.
I don’t remember them even talking about it, except to pooh-pooh people who complained about the health care system. We have the best health care system in the world, after all [/scarcasm].
In 2009, President Obama started working on health-care reform, and Republicans again insisted they really truly did want to reform the health-care system, just not in this particular way. Plan? TBD. Then they won control of the House and promised to immediately get to work on a replacement plan. Result: zero. Evidence of any progress toward said plan: zero.
Recently Rep. Paul Ryan told editors of the Washington Examiner that it would be a mistake for Republicans to offer any specific legislation before the November election. Instead, they should offer a “vision.” I take it “vision” is the new “bullshit.”
Back to Jonathan Chait:
In the same interview, Ryan says maybe Republicans will reform the deductibility of health insurance: â€œOn tax treatment of health care, some of our folks really like deductions, others like the tax credit route.â€ That sounds like a possible first step. Except the Ryan budget already assumes that it will close trillions of dollars in tax deductions like that for employer-provided health care, and then it plows all that revenue back into lower tax rates. So, no money for tax credits or any other way to support health insurance.
The health care system is very complicated and made up of countless moving parts that have to work together. That’s why the ACA was so long and complicated. I think Republicans are not intelligent enough to come up with their own legislation, and I will believe that until they prove me wrong and come up with something. And at the rate they are going, I won’t live long enough to see that.