Thanks, GOP (Seriously!)

All of us who favor expanding healthcare coverage to include all Americans owe a debt of gratitude to Republicans. I know, I know, the GOP has tried to repeal Obamacare more times than most of us can count, and right-wing Republican state attorneys general and governors brought the suit in which a Texas judge declared the entire Affordable Care Act unconstitutional. But, that is the point: The more Republicans object to modest proposals to expand health coverage for middle- and lower-class Americans, the more the nation’s appetite will be fueled for a bigger government role in health care.

A recent poll by the Progressive Policy Institute found voters — by a margin of 54-46 percent — favor changing “the current health care system so everyone gets health care through Medicare instead of through people’s place of work or instead of buying it directly.” Nearly half of Republicans agreed with Medicare-for-all. The public’s current receptivity to government-guaranteed health coverage for everyone is a far cry from the vehement initial opposition to Obamacare. The favorable poll findings reflect the success of Obamacare and the continued Republican opposition to it combined with the party’s inability to craft a plausible alternative.

In the short run, the judge’s ruling changes nothing, though the decision — coming at the end of the open enrollment period for Obamacare — caused some confusion. The administration says the law remains on the books until all appeals are exhausted, which could take a year or more. But, that did not stop President Donald Trump from taking a victory lap, tweeting immediately after the ruling: “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch [Senate Majority Leader Mitch McConnell] and Nancy [likely new Speaker of the House Nancy Pelosi] get it done!” 

Not likely, at least not before the next presidential election. The court decision puts the Republican Party in an awkward position, balancing the president’s gleeful tweets with the public’s growing realization that GOP policy threatens the health insurance more than 20-million Americans obtain through the marketplace and the expansion of Medicaid. The Democratic success in painting Republicans as opponents of government health insurance helped the party win control of the House in last month’s midterm elections. Democrats will continue to keep health care in the public spotlight, holding hearings to highlight the potential sweeping impact of the Texas ruling while trying to convince voters that returning the party to the White House in 2020 is the only way to protect and expand coverage. The Democratic message for the next two years will be a continuation of the one that helped them flip roughly 40 House seats last month: Republicans are hellbent on gutting Obamacare and rolling back protections for things like pre-existing conditions. “It’s all downsides,” a House GOP aide said. “Politically, I don’t think that it [the Texas ruling] helps us at all.” 

The court decision is not likely to stand, but if it did it would create major disruptions in the healthcare system, influencing the cost of the drugs patients buy, making unavailable preventive services for older Americans, curbing the expansion of Medicaid in most states, undermining coverage for pre-existing conditions, and more. “There’s really no American that’s not affected by this law,” said Yale law professor Abbe Gluck. She added that the judicial ruling contradicts settled legal doctrine and challenges the prerogatives of Congress.

Judge Reed O’Connor

Judge Reed O’Connor ruled against the entire ACA on the grounds Congress’s decision to reduce to zero the penalty for not having health insurance rendered the individual mandate to buy coverage unconstitutional, and, thus, the entire law must fall. This was the argument of the 20 states that brought the legal challenge to Obamacare. Most legal experts say that rationale is unsound because even though Congress removed the tax, it did not touch the remainder of the law. The long-standing legal doctrine of “severability” holds that when a court declares one provision of a statute unconstitutional, it should leave the rest in place unless the legislature explicitly states the law cannot stand without the severed portion. In this case, the intentions of Congress were clear: It amended only the tax provision. In fact, prior to the new tax law, Congress upheld the ACA when it failed to repeal and replace it, despite the clear desire of the president and most Republicans. 

Missouri Republican Senator-elect Josh Hawley

Republicans have been less than consistent on the issue of Obamacare lately, caught as they are between their eight-year unsuccessful quest to repeal the law and the growing public fondness for it. Nothing illustrates the dilemma of Republicans on health care more than the senatorial campaign in Missouri of Josh Hawley, who won his seat because he convinced voters that he was for protecting people with pre-existing conditions even though as Missouri’s attorney general he signed the legal complaint that was the basis for Judge O’Connor’s ruling. Hawley ran an ad featuring his son, who has a rare chronic disease — a pre-existing condition. In the ad, Hawley said, “I support forcing insurance companies to cover all pre-existing conditions.” Hawley neglected to inform Missouri voters that in the lawsuit he sponsored all of Obamacare — including coverage for pre-existing conditions — would be removed. 

Missouri voters were fooled, but the Republican ability to have it both ways on health care likely will not continue, especially as Democrats shine a spotlight on such hypocrisy. The sponsorship by red state officials of the Texas lawsuit proves that Republicans may say they favor parts of Obamacare, but what they really want is to gut the entire law. Public understanding of the GOP’s wanting it both ways will embolden progressive Democrats to push for more and better healthcare coverage — letting, at the least, middle-age Americans buy into Medicare. The eventual outcome will be guaranteed health insurance for everyone.

It is only a matter of time. Thanks, GOP!

Posted December 18, 2018

Comments are closed.