The campaign to let 20 million Americans keep their health insurance is working.
It still has a long way to go, and it’s not guaranteed to succeed. But the progress of the last couple months is remarkable.
Thanks in part to a surge of activism – town hall meetings, online postings, calls to Congress – the politics of Obamacare have flipped. Many Americans have come to realize that the care part of the law matters much more than the Obamapart. As a result, the Republicans no longer have a clear path to repeal.
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President Donald Trump, in his speech to Congress on Tuesday night, will probably pretend otherwise. He may repeat the same magical promises to pass a bill that’s better and cheaper and covers everyone. Privately, though, he and his aides have begun to realize the mess they have made by promising the impossible.
On Monday, Trump himself lamented that health care was “complicated.” The clearest sign of anxiety came in a Washington Post report: Four top advisers – Stephen Bannon, Gary Cohn, Jared Kushner and Stephen Miller – “have emphasized the potential political costs to moving aggressively.” Those costs include taking the blame (fairly or not) for every problem in the insurance market.
Meanwhile, congressional Republicans have their own troubles. As of now, they don’t have the votes to pass a plan.
Unable to agree on a policy, the party’s leaders have settled on what The Wall Street Journal called a “gamble” and a “dare.” They will push ahead with a now-or-never repeal bill, hoping that party loyalty will ultimately overcome substantive disagreements.
Why are Republicans suddenly having such a hard time agreeing about their No. 1 priority? They’ve run into two obstacles: reality and public opinion.
Let’s start with reality. Republican leaders are now paying the price for their dishonest approach to fighting Obamacare.
To be clear, there are honest conservative attacks to make on Obamacare. Republicans could have said that Americans who can’t afford health insurance aren’t entitled to it, just as people are not entitled to own a home. Or Republicans could have tried to alter the law – say, with less generous insurance plans.
But Republican leaders chose the easy political route instead. They blamed Obamacare (sometimes fairly, mostly not) for almost every health care problem. They’ve promoted the same fallacy for which conservatives often mock liberals: the free-lunch fallacy.
There is no free lunch on health care. Your health “costs” pay for my health “benefits,” and vice versa. If Trump promises a less expensive system, he is also promising to eliminate some care. He could cut wasteful care – and should – but Republicans caricatured the Obama administration’s attempts as “death panels” without offering their own steps.
Now that they’re running the government, free-lunchism has consequences. Their promise to scrap taxes on the wealthy, for example, leaves them without money to cover people. That’s why the independent Congressional Budget Office keeps concluding that the various Obamacare replacement plans would deprive millions of people of insurance.
More Americans have begun to understand these realities, and everyone engaged in the grass-roots campaign to protect health insurance deserves to take pride in the change. People have seen YouTube clips of town hall meetings at which members of Congress have no good answers. Some people are also starting to see through Trump’s wait-till-next-month timetable.
Most Americans still have complaints about Obamacare. So do I. (Some subsidies are too small, as are the penalties for not signing up.) But they increasingly realize that no serious alternative exists – still. Getting rid of Obamacare means taking away health insurance, and medical care, from millions of people.
No wonder the polls have flipped, and more than half the country now supports the law.
One group to watch is Republican governors. They met in Washington this weekend and tried to come up with an approach that would help their colleagues in Congress. But they couldn’t. Too many Republican governors understand that a repeal would create major trouble. To their credit, some aren’t willing to fake it.
Still, this is no time for complacency. Republicans have spent so long promising repeal that failure would leave them vulnerable to primary challenges and make them look weak. They have many incentives to pass a bill.
But aficionados of irony will appreciate the fundamental source of their struggles. In drafting his health care plan, Barack Obama chose a moderate, market-based approach. It was to the right of Bill Clinton’s and Richard Nixon’s plans and way to the right of Harry Truman’s – and yet Republicans still wouldn’t support it.
Many liberals regret that decision. Obama, for his part, believes that a more left-wing version would not have passed. Either way, the version that did pass doesn’t leave Republicans much room to maneuver.