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McConnell's Obamacare Policy—Repeal It, Then Immediately Reinstate the Whole Damn Thing

Win McNamee/Getty Images

I think there's one way, and only one way, to interpret Mitch McConnell's position on the Medicaid expansion in Kentucky, and last night the Washington Post's fact checker confirmed it. McConnell wants to repeal the Medicaid expansion (along with the rest of Obamacare) and then let the people who run the state of Kentucky (i.e. people other than him) decide whether to reinstate it, and pay for it out of state coffers.

That's a difficult position to support, which explains why his campaign obscures it behind a bunch of rambling designed to convince people (including very politically savvy people) that McConnell has come around to supporting the Medicaid expansion.

But it's actually identical to his position on Kynect—the state's health insurance exchange—and perhaps he'll apply it to other integral parts of Obamacare as well. As a general matter it amounts to arguing that Obamacare should be repealed, and then reinstated in full at the state level. But that's a total fantasy.

When Obamacare is repealed, the funding Kynect relies upon, as well as the health plans and rules that make it a popular and widely used portal, will disappear as well. No biggie, says McConnell. Once they're gone, the state can decide whether it wants to reinstitute those things on its own.

But of course, as with Medicaid expansion, it's almost impossible to imagine states riding to the rescue of those harmed by Obamacare's repeal. Running the exchange is fairly expensive on its own, but its costs would dwarfed by the resources required to recreate the actual market Obamacare has created in Kentucky. Remember, Kentucky flirted with creating Obamacare's coverage guarantee without creating any incentives for everyone to purchase insurance. No mandate, no subsidies. And the system predictably collapsed. But it's unlikely that Kentucky could afford to reinstate ACA-style subsidies on its own. And without them, the plans will be too expensive to justify a mandate. And so under McConnell's policy, Kentucky's newly insured would be left with nothing.

The idea that ACA politics are gruesome for Democrats is so deeply ingrained in the national media's belief system that it won't be shaken loose by McConnell's dissembling alone. But if it were true, why would Republicans across the country be hiding their true views about Obamacare behind the word "fix"? Why would any Republicans, let alone the Senate GOP leader, be saying they want to get rid of everything Obamacare does except the things it does in their own states?