(Bloomberg Opinion) --
Remind me again what the Republican position on health care is?
I’m pretty sure that Republicans oppose Obamacare and still intend to introduce a plan to replace it any minute now. They also will tell you that they absolutely will not take away protections against preexisting conditions and other Affordable Care Act benefits. They also, however, are backing a Texas lawsuit that would, if successful, knock out the entire law, including all of those protections, and replace it with, well, chaos.
Oh, and meanwhile? State by state, my prediction that the Medicaid expansion made possible by the Affordable Care Act would eventually be universal is slowly coming true. Most Republican governors had originally rejected expansion and the federal money that finances it, but plenty of them are agreeing to compromises to make it happen. The latest? Kansas. That leaves 14 states to go, although those 14 still include both Texas and Florida, so we’re still talking about a lot of uninsured people.
Greg Sargent of the Washington Post flags the key quote from one prominent Republican, who admits that the fight over Medicaid expansion is over and his side lost.
And yet … there’s that lawsuit, which could wind up disrupting everything. And there’s Texas, Florida, and the other 12 holdouts, where Republicans fight on even though it gives Democrats a popular issue to campaign on.
The truth is that the future of Medicaid expansion (at least assuming the courts don’t overturn everything) was clear as soon as states that flipped to Republicans after the 2014 election failed to repeal it. Medicaid expansion has always been a one-way street: Once a state adopts it, its citizens like it, or at least they like it enough to keep it. It was easy to see why from the start. The Affordable Care Act introduced plenty of fundamental reforms that would be extremely disruptive to undo in an attempt to return to the status quo ante, whether or not they were good ideas in the first place.
In part, that’s the nature of government programs: Conservatives are correct that once people have something, they’re reluctant to give it up. But especially in this case, the health-care system before 2010 was in many respects unpopular and, even worse, unstable, and on its way to something worse. A conservative political party that focused on policy innovation could, presumably, come up with ideas that would tackle the continuing problems of the system without increasing the reach of the government. The Ronald Reagan Republicans were, to a large extent, that kind of party. But that party has long since disappeared, and the Newt Gingrich/Mitch McConnell/House Freedom Caucus/Donald Trump Republican Party has nothing more than empty slogans in most policy areas. Plus radical judges and the occasional lawsuit that party operatives hope won’t win because they fear the electoral blowback if it does.
At any rate, unless the lawsuit knocks things off course or some new reform makes the whole thing moot, it’s going to be interesting to see how much pressure the holdout states feel to finally accept Medicaid expansion. It took 17 years for Arizona, the final state, to adopt the original Medicaid after 1965. That leaves a bit over seven years for the 14 remaining states to get there if the pace is the same. Sounds not too far off to me.
1. John Sides at the Monkey Cage on Trump’s approval ratings and the 2020 presidential election.
2. Also at the Monkey Cage: Dina Esfandiary on Iran’s Revolutionary Guard.
3. Dan Drezner on U.S. soft power.
4. Calvin TerBeek at A House Divided on Justice Clarence Thomas, purist.
5. David Weigel chats with staffers from four of the defunct presidential campaigns. Excellent.
6. Reid Wilson on partisan polarization in state legislatures.
7. My Bloomberg Opinion colleague Justin Fox on state-to-state U.S. migration.
8. And Nate Silver and the gang at FiveThirtyEight have a new prediction model for the Democratic nomination and the upcoming caucuses and primaries. Will it actually predict anything? I have no idea. But it should show, at least to a pretty good extent, what will happen if past patterns apply this time around. That said: Given the chances the model spits out, I’d be selling on Bernie Sanders and a contested convention, and buying on Elizabeth Warren and Amy Klobuchar.
To contact the editor responsible for this story: Jonathan Landman at jlandman4@bloomberg.net
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Jonathan Bernstein is a Bloomberg Opinion columnist covering politics and policy. He taught political science at the University of Texas at San Antonio and DePauw University and wrote A Plain Blog About Politics.
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