The Republican Party’s campaign of maximalist opposition to the Affordable Care Act began almost seven years ago, and has continued through the law’s passage to this very day.
One of the first things Republicans did when they gained control of the House in 2011 was pass legislation to repeal Obamacare. They have supported multiple lawsuits aimed at eliminating or eviscerating the law, discouraged the uninsured from securing its benefits, and shut down the government in protest of the law’s implementation.
At some point along the way—several years ago now—Republican Party leaders accepted that their efforts to sabotage the law needed to be paired with gestures to the idea that the law should be replaced. Their repeated failure to turn those gestures into legislative action quickly became an emblem of the party’s basic indifference to this issue. And now a new development—the Democrats’ ongoing, intra-party argument over the future of American health policy—has thrown the GOP’s indifference into even sharper relief.
Once it became clear that the Affordable Care Act would be implemented, and its benefits would spread, Republican strategists conceded that promising to repeal the law outright, without a plan for displaced beneficiaries, was a recipe for political disaster.
But none of them had any clue how to replace Obamacare, let alone how to unite the party behind a single alternative to it. Indeed, the GOP has never really been able to achieve unanimous agreement that the law should be replaced at all, or on anything other than the certainty that the government is helping to insure too many people.
Liberal commentators have made almost no effort to disguise their amusement whenever Republicans retreat from the challenge of forging a health care reform consensus, as they have at regular intervals.
Their less-than-complete commitment to replacing Obamacare finds perfect expression within the Republican presidential primary. In more hopeful days, before Donald Trump became the overwhelming poll leader, Scott Walker, Jeb Bush, and Marco Rubio all aligned behind the view that a less generous, less expansive, less regulated insurance coverage scheme should replace the Affordable Care Act. Then Louisiana Governor Bobby Jindal lashed out in response, arguing that the GOP’s Obamacare alternative should be less generous and less expansive still.
Today, Jindal and Walker are no longer running for president, and Rubio and Bush almost never mention their health plans. Republicans on the trail and on Capitol Hill barely talk about health care at all, except to reiterate undying antipathy to Obamacare. Just a few days ago, the GOP Congress finally sent completed legislation that would cripple Obamacare to the White House for a veto. They then “demurred on whether they would write and vote on a bill this year.”
It’s slightly misleading, but not inaccurate, to say that Democrats are also engaged in a debate over whether and how to replace Obamacare. But to the extent that they are, it is a far more serious and deeply felt debate than the one Republicans are having.
At their final pre-Iowa debate on Sunday evening, Hillary Clinton and Bernie Sanders went multiple rounds on the issue, with Sanders insisting that the federal government should consolidate all health spending subsidies into a single-payer system, and Clinton arguing both that Sanders’s plan contains weaknesses, and that, on a pragmatic basis, it would be wiser for Democrats to build upon and strengthen the post-Obamacare status quo, rather than dive back into another contentious debate over a much more radical health care reform agenda.
Liberals generally agree that a single-payer system (or a multi-payer system with a fully subsidized government option) would be preferable in the abstract to the heavily balkanized health care system we have today. They are at the same time divided over questions of whether and how to pursue it as a near-term political goal. Clinton spokesman Brian Fallon told MSNBC’s Chris Hayes that she would support allowing consumers to buy into a public health insurance option—something that would both contain costs, increase the insured population, and potentially evolve into a Sanders-approved government plan over time, while avoiding the disruption that a quantum leap to single-payer would cause.
Sanders, meanwhile, continues to argue that the health insurance system needs a radical and immediate overhaul. In response to the Clinton campaign, he introduced a partial blueprint of the coverage scheme he’d pursue as president, and how he’d pay for it. He offered much less detail on how he’d use government leverage to guarantee the systemic savings he’s promised to deliver, and many liberals are thus demanding those specifics from him.
The Democratic Party paid an enormous political price for devising, passing, and implementing the Affordable Care Act, and many Democrats are understandably beset by fatigue, or unwilling to sign up for a new campaign premised on the view that the program they just created isn’t worth building upon, or experimenting with for at least a while. As the party is drawn deeper into a fight that’s pitting its idealists against its pragmatists, its activists against its eggheads, many officials are looking on, if not with horror, then with dismay.
But in determining where the party’s health policy platform should go from here, this is what the fight was always going to look like: committed people with considered views unpacking a complicated issue they all feel passionately about. Republicans are understandably delighting in the division the debate has sown, and hoping that activists win the fight. They seem comparably unaware that this is how politicians who care about the health of all citizens argue amongst themselves. As bitter and politically fraught as it is, the liberal health care fight represents a more mature debate over repealing and replacing Obamacare than the right has mustered in six years.