Repeal Rhetoric Remains, But Spirit Might Not

(Bloomberg Opinion) -- With yet another run at the Affordable Care Act rumored for later this summer, I’ll point everyone to an excellent item over at the Monkey Cage by Eric Patashnik and Jonathan Oberlander explaining why Republicans are still trying to repeal this law so many years after it was passed. As they point out, this differs from how Republicans handled Social Security or Medicaid and Medicare.

This is something I’ve been more or less wrong about. I’ve thought that eventually we would get back to the normal politics of health care, in which Republicans would accept the basic structure but try to make benefits less generous and taxes lower or less progressive, while Democrats would do the opposite. That’s happened to some extent, but certainly the rhetoric of repeal hasn’t cooled much, and neither have some fairly serious attempts at repeal.

The real danger for Republicans is that they’ll wind up pushing Democrats into a more radical reform. Had Republicans mostly just trimmed spending some, then Democrats (whenever they next got the chance) would simply restore and increase it. Even if that had to be done through legislation, and not the even-easier appropriations process, it’s likely that Democrats would have had other priorities. Now, however, the elimination of the individual mandate and other changes threaten to destabilize health-care markets, and Democrats are going to feel the need for a fairly major health-care bill to fix things.

Once they do that, however, the pressure will be on to do more than just restore the 2016 status quo. It’s not so much that Bernie Sanders has them all in a single-payer frenzy. It’s that Democrats may feel it’s just as easy to pass a major expansion of Obamacare as it is to fix it. They may also no longer believe that retaining the market structure of the Affordable Care Act buys them either Republican allies or moderate reputations. And they may also decide that a more radical reform will be more permanent. Looked at in one sense, the Affordable Care Act was designed to be as easy to pass as possible, but a “Medicare for All” system might be a lot harder to repeal because it would be more visible. 

Meanwhile, I wouldn’t rule out the possibility that Republicans will manage to pass a major health-care bill in either this Congress or, should they retain their majorities, the next one — but I think it’s very unlikely. It remains painfully obvious that Republicans don’t have the capacity (and may not care enough) to fashion a real replacement for Obamacare, and that means that any repeal bill will leave quite a lot of voters very visibly worse off. That’s true even though many of those voters may not realize that they are currently benefiting from the Affordable Care Act. Now, Republicans could move ahead anyway, but they’ve shown very little appetite for it and are probably several votes short in the Senate right now. They were several votes short last year and came remarkably close to passing something anyway; it’s possible they could back into something that might hurt them electorally. But I suspect their hearts aren’t in it. 

1. Dave Hopkins on the latest primary elections. 

2. John Sides at the Monkey Cage reports on the first in a planned series of polls on the 2018 election

3. Also at the Monkey Cage: Allison Spencer Hartnett on the future in Jordan

4. Dan Drezner on the Singapore summit and why it just wasn’t very important. 

5. Don’t fall for the #cleverfallacy: Read my Bloomberg Opinion colleague Timothy L. O'Brien on President Donald Trump’s latest dance on the world stage

6. And an interesting view of Trump’s influence on primaries from Reid Wilson. 

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