It only took two consecutive midterm wave elections, 62 votes, a change in House leadership, a presidential election year, a lot of backroom deals, and a once-a-year reconciliation budget bill, but congressional Republicans finally did it. For the first time, the Republican-dominated Congress has sent a bill to President Barack Obama repealing the Patient Protection and Affordable Care Act. What’s more, the measure also strips Planned Parenthood of all taxpayer-provided support. Ominously, no one is happy about it.
According to Real Clear Politics reporter James Arkin, the bill is a substantial victory for House Speaker Paul Ryan on several counts. This marks the first occasion in the nearly six years since ObamaCare passed that Congress has ratified its repeal. This move will likely eliminate the need for the legislature to spend any more of an election year passing meaningless repeal votes. It’s also the first time the president will be compelled to use the veto pen – only the eighth time in his presidency – to defend the deeply unpopular health care reform law. Given that even Hillary Clinton has professed support for changes to the existing law, this is a veto the Democratic nominee will be hard-pressed to defend beyond rote talking points about the heartlessness of stripping the insured of the substandard coverage that many cannot afford. Finally, this frees up congressional Republicans to pursue a reform agenda and set the table for 2016. Those legislative packages the speaker previewed include passing an ACA replacement plan, crafting tax and welfare reform bills, and a variety of other conservative reforms. It is a ready-made governing agenda that the Republican presidential nominee can truthfully contend would be “ready to go on day one.”
Given the far-reaching nature of the effect this bill will have for Republicans, it’s curious that it’s primarily Democrats who seem to be aware of it.
Calling the repeal bill a “train wreck,” New York Magazine’s Jonathan Chait defended the law by contending that more Americans were getting coverage (possibly in order to avoid costly penalties for noncompliance) and that medical costs were going down. The majority of his defense of ObamaCare was, however, spent litigating the predictions of conservative writers and publications about the future of the law that never panned out. In their defense, few conservatives predicted that 10 of the 23 insurance cooperatives, established with the help of $2.4 billion in ACA-enabled loans, would become insolvent and be forcibly shuttered before the end of 2015. Who could have guessed?
The Affordable Care Act’s key support structures, the individual and employer mandates, are also under attack in Congress’s repeal bill. While the employer mandate is so onerous and unpopular that it has never been implemented, and even some administration supporters believe that it will soon be mothballed permanently, the individual mandate to purchase insurance would be struck down if Obama were by some miracle compelled to sign this bill into law. Los Angeles Times contract reporter Jon Healey contended that this is a disastrous proposal, because it would compel the sickest Americans to sign up for care only when they need it and drop insurance when they don’t, causing existing premiums to jump. He might not have noticed that premium rates for the inaptly named Affordable Care Act’s plans are already slated to spike by as much as 60 percent this year for some providers. “Insurers say they want to hike rates because enrollees are going to the doctor, getting lab work and filling prescriptions more than they had originally anticipated,” CNN reported last summer.
“When Kaiser recently studied the approximately 10.5 million eligible Americans who remain uninsured, they found that more than 7 million of them would be better off paying the penalty than paying the exorbitant price of an Obamacare plan,” wrote the Independent Women’s Forum senior policy analyst Hadley Heath Manning. “The only consumers happy with Obamacare’s premium prices, it seems, are those who are heavily subsidized, as some 80 percent of current enrollees are.”
Repeal and replacement of the ACA remains by every objective measure a worthy goal. Yet this incremental victory so long in the making has prompted precious little commentary, positive or otherwise, among conservatives. Conservative media outlets have declined to game out its effects on the 2016 race, and they haven’t spent much time comparing the presidential candidates’ distinct health care policy preferences. These conservative voices are not misguided; they have accurately assessed the public mood.
A New York Times/CBS News poll conducted in early December 2015 found just 3 percent of respondents rated health care as their top priority issue, well below terrorism, Islamic extremism, the economy, and immigration, among other issues. A late December Quinnipiac University poll confirmed those findings, noting that Republicans were less likely to rate health care as their top priority than they were the economy and jobs, immigration, terrorism, the deficit, and even foreign policy in general. That poll also found, however, that Democrats were much more inclined to rate health care as their single most important issue. Only foreign policy and the economy rated better among self-identified Democrats.
The irony here is that Republicans in Congress will be judged to have again misread their base voters by pursuing ObamaCare’s repeal – an agenda item that has ranked near the top of the GOP’s grievances with this administration since 2010. Those conservatives who are not inclined to view this latest maneuver as a stunt or a modest gesture that comes too late to shape their opinions of GOP leadership in Congress are simply too few to shape the opinion landscape. The other side of the aisle, meanwhile, is much more likely to be energized by a repeal vote – and their energy will only help Democratic politicians at the polls.
This is an ominous development for opponents of the Affordable Care Act. While repeal might be good policy, it is becoming less attractive politics. For conservatives who have crusaded against this law for over half a decade, their opportunity to finally be in a position to do something about it might have come too late to matter.