Last night's Republican presidential debate featured an interesting exchange about health care -- I haven't been able to locate a transcript, but the gist was that Rick Perry was asked why Texas has the highest rate of people with no health insurance in the country (over a quarter of Texans have no insurance), and he responded that it was the federal government's fault, because they aren't giving states enough "flexibility" in Medicaid.
From the standpoint of logic, this is obviously pure nonsense -- if the reason so many people have no health insurance was that the federal government isn't giving people good enough health insurance through Medicaid (an odd argument coming from an anti-government Republican to begin with), then every state would be affected equally, and Texas would be no worse off than anyone else. Nevertheless, it was a revealing answer.
The problem Perry has in answering questions like this one is that he has no generalized interest in health care. He has some specific complaints, perhaps the biggest of which is that Medicaid, which is jointly funded by the federal and state governments, costs him money he'd probably like to spend elsewhere, and also imposes requirements on how insurance is granted -- most important, it requires that everyone who qualifies for the program has to be given insurance. The "flexibility" Perry and other Republican governors are after is mostly the ability to save money by dropping people from the rolls (I explained here). Which of course produces more uninsured.
There are one or two other health care questions Perry is interested in – for instance, he's interested in making it almost impossible for people to sue for medical malpractice (aka "tort reform") which Texas has done, and which improved medical insurer's profits but did nothing to reduce medical costs. The point is, though, that when asked about a health care question he really isn't concerned with – in this case, the uninsured – Perry doesn't really know where to go except to repeat his standard complaint about the federal government.
In this sense, the Affordable Care Act was actually a gift to Republicans, because it gives them something to talk about when the issue of health care comes up. Democrats, who are much more interested in the issue, have for decades had lots of things they wanted to do on health care, and lots of proposals for how to do them. Republicans, on the other hand, have tended to ignore it until public pressure reached critical mass, at which point they'd say, "Um, yeah, we, um…want a Patient's Bill of Rights! That's something, right?" But now they have an answer to almost any health care question: Repeal the ACA!
UPDATE: Transcript is available here, and Perry's answer is even more inane than it seemed last night. When asked why Texas has so many uninsured, he says, "Well, I'll tell you what the people in the state of Texas don't want: They don't want a health care plan like what Governor Romney put in place in Massachusetts. What they would like to see is the federal government get out of their business." That goes on a bit, and then there's a follow-up question, asking him again why there are so many uninsured in Texas, and he says, "Well, bottom line is that we would not have that many people uninsured in the state of Texas if you didn't have the federal government." Okeley dokeley.
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