Senate Republicans seem to think that their Democratic counterparts will work with them on a bipartisan basis on health care reform. They’re right. The only problem is that they think that lifeline will come after they repeal the Affordable Care Act, rather than beforehand.
Republicans believe that they can move forward on their partisan promise to eliminate the Affordable Care Act and expect Democrats, standing in the rubble of the Obama administration’s signature achievement, to extend a hand to Republicans and offer them a political win. Once Republicans have elected to repeal Obamacare on a party-line reconciliation vote, the GOP’s thinking goes, Senate Democrats will be under pressure to vote for a to-be-determined replacement that likely won’t cover as many people as Obamacare does and wouldn’t ideologically suit Democrats but may be better than the post-repeal status quo of total chaos and horror. Republicans wouldn’t need most Democrats’ or the Senate Democratic leadership’s blessing. They’d just need to pick off eight endangered Democrats.
A Thursday piece in Politico titled “Democrats Open to Replacing Obamacare” implies that Republicans may be onto something. “Twenty-five Democrats are on the ballot in 2018, including 10 in states that Donald Trump just won,” Politico writes. “The GOP is betting that many or most in the latter group will be under irresistible pressure to back an Obamacare replacement, if the alternative is leaving millions of people in the lurch without insurance.” Politico spoke with several Democratic senators in this supposed political vise and determined that “the Republican strategy may not be far-fetched.”
Eh, it’s pretty far-fetched. Most of the Democratic senators Politico is speaking to aren’t saying they’re “open to replacing Obamacare.” They’re open to fixing Obamacare, the notion of which goes out the window once Republicans vote to repeal it. Democrats are extending the hand now. Their incentive will be to withdraw it, and keep it withdrawn, once Republicans repeal Obamacare and take ownership of health care.
“[R]eplacing it could draw bipartisan backing,” Politico writes, “as long as the changes are more adjustment than overhaul.” This is a strange sentence. Any “replacement” would come after a repeal of the law, which by definition is more of an “overhaul” than an “adjustment.” One doesn’t “adjust” a void.
Most of the quoted Democratic members make this distinction. They’ll help Republicans if they’re open to fixing the law, but tossing the whole thing and building from scratch is more than a fix. “If [Republicans] want to change things around the edges, fix some of the things we agree ought to be fixed and call it Trumpcare, that’s OK,” said Sen. Angus King, the Maine independent who caucuses with Democrats. Likewise, Sen. Chris Coons, of Delaware, said that “[i]f there is a path toward saving the best parts of Obamacare that are actually helping deliver affordable quality health care to millions of people while addressing some of the challenges, flaws and weaknesses of Obamacare, we should work hard with Republicans on that.” Sen. Tim Kaine, as Talking Points Memo reported in another recent piece, drew the clearest line. “If they came to us and said we would like to talk to you about something, and we’ll call it replacement and you’ll call it reform, we would sit and talk, but if it starts with repeal, they’re telling us they don’t want us involved.” They’re all talking about fixing what exists. They’re not talking about lending a set of hands to help construct the new reform Valhalla of tort reform, market deregulation, and health savings accounts.
Democrats have every reason to stand firm on this, be it to give Republicans pause before they do something damaging or, in the more certain case that they go through with it, to make them own the consequences. After repeal, Republicans will own health care, and it will be their problem to fix. Owning health care in America means owning a lot of thorny, difficult problems even in peacetime, like medical inflation. Ask Democrats how much they’ve enjoyed the politics of owning health care over the last six years. Though they’ve accepted it as a trade-off for the benefits the Affordable Care Act has offered over those years, Democratic members have not enjoyed getting a nasty phone call every time a constituent got a big bill for a visit to the doctor’s office. By repealing Obamacare, Republicans will take ownership of everyone’s existing health care problems as well as the 20 million or so new ones they create through repeal. Republicans think that they can induce Democrats to put bipartisan fingerprints on whatever replacement they conjure to create co-ownership of health care and disarm the issue. Unless Republicans can offer Democrats something that looks a lot like what they had already or meets similar coverage numbers as the ACA—i.e., something that’s politically unpalatable to Republicans—Democrats as a whole would have little incentive to remove Republicans from the political meat grinder they’ve lunged into.
“Leaving millions of people in the lurch without insurance” is what Republicans will be doing if they repeal the Affordable Care Act. And if they’re truly worried about the consequences when they can’t get 60 votes for a replacement, Democrats can provide them the last-minute votes—to extend Obamacare. It’s laughable for Senate Republicans, led by Mitch McConnell, to try to convince Democrats that they’ll face political consequences if they choose obstructionism rather than working on a bipartisan basis. The majority should consider itself fairly warned by its own past behavior and take the deal now. Of course, it won’t.