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House Republicans Are Quietly Giving in to Obamacare

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A week and a half ago, when House Republican leaders realized that their own conservative members might align to defeat legislation protecting Medicare physicians from a big automatic pay cut, they took the unusual step of cutting them out of the tangle altogether.

While negotiations were ongoing, the Majority Leader, Eric Cantor, darted on to the House floor and, after brief consultation with Democratic leaders, cleared the Medicare "doc fix" by voice vote—a procedure that's typically reserved for fast tracking uncontroversial legislation. The yeahs and nays were not recorded. A bill that divided the GOP conference, and might very well have failed in front of God and everyone under the leadership's own rules, had passed the House before many Republicans even knew what Cantor was up to. 

He and other Republican leaders have been busily making amends with conservative rank and file members ever since. Those members were understandably furious about the breach of protocol, but some were privately grateful that the bill had passed—even if they would have voted against it had Cantor not done a shady end run around them. Everyone wants to play the fiscally responsible part but nobody wants to answer to the doctors and the Medicare beneficiary when the bill fails, which helps explain the recent thaw. 

But I wonder how many of them knew at the time, or know now, that the leaders used the same doc fix bill to smuggle a bipartisan Obamacare fix through the House uncontested.

The tweak itself is relatively minor. It eliminates a provision of the Affordable Care Act that capped deductibles for small-group health plans at $2,000 for individuals and $4,000 for families. 

But when the Associated Press laid it all out on Sunday—including the fact that GOP leaders sought the fix at the behest of powerful business organizations—Matt Drudge freaked out and accused Republican leaders of "expanding Obamacare."

Republican leaders rejected that interpretation, noting that what they actually did was repeal a provision of the law, in a way that redounds to the benefit of small business owners. 

But Drudge has a point, too. The change will make expanding coverage under Obamacare marginally easier. And to the extent that it helps small business owners, it weakens the already splintering coalition of interest groups and movement leaders who support repealing the law in its entirety. 

Indeed, now that Obamacare has taken root we're seeing the green shoots of conservative acquiescence cropping up all around it. A full month ago, the House passed three minor ACA tweaks—to address the concerns of Christian Scientists, volunteer firefighters, and companies that employ veterans (who are already provided health coverage by the government). 

At around the same time, 18 House Republicans broke a silent embargo against the law by signing on to a letter to Health and Human Services Secretary Kathleen Sebelius asking her to make minor improvements to in the interest of easing enrollment. As enrollment mounted, the center of GOP opposition began to shift away from those who believe enrollment ought to be discouraged, or at least not facilitated, toward those who take their duty to their constituents more seriously. 

None of these modifications will substantially change the ACA's architecture or even smooth its roughest edges. But they badly undermine longer-standing Republican claims that the law is beyond fixing. If parts of it are clearly fixable, and being fixed, then new constituencies will come out of the woodwork seeking changes of their own, and resistance to more substantial ones will become harder to maintain. For instance: Right now, the ACA faces a remote but real threat thanks to a drafting error in the law, which, taken out of context, suggests that residents in states without their own exchanges (i.e. states) are not entitled to insurance subsidies. 

It's difficult to imagine the Supreme Court creating this kind of chaos over decontextualized sloppy language when the statute read in its entirety is unambiguous. But Congress could moot the legal challenge in a single afternoon. A technical corrections bill would eliminate a real source of anxiety for insurers, providers, consumers, and even politicians from states. And the logic against passing such a bill just became much weaker. 

It's easy to see how the slow roll of these minor changes might snowball into something larger and more undisguised over time. Meaningful amendments that don't need to be sneaked past conservatives using procedural chicanery.

But conservative hardliners aren't ready to give up the ghost just yet.