Republicans Possibly Pretending to Be Mad At Other Republicans Definitely Pretending to Care About Health Care

The Supreme Court will rule on the constitutionality of the Affordable Care Act soon, and that has concentrated some Republicans' minds. It was all well and good to shout "repeal and replace!" when there wasn't really anything they could do about it, but if the Court actually strikes down some or all of the law, they'll be under greater pressure to put their money where their mouths are. The central quandary is this: if the law's least popular provision—the mandate for everyone to carry insurance—is struck down, that means the law's most popular provision—the requirement that insurance companies accept everyone, regardless of pre-existing conditions—has to go as well. Not only that, some other popular provisions, like the requirement that insurers allow young people up to age 26 to go on their parents' insurance, would disappear if the Court strikes down the whole law.

Should that happen, President Obama and other Democrats will immediately begin attacking Republicans for taking away these popular benefits. After all, the overturning of the ACA is a Republican project from start to finish, from the lawsuits brought by Republican attorneys general to the Republican judges on the Court who will undo it. So what do you do if you're a Republican member of Congress? Well, you start pretending that when you get around to that whole "replace" thing, you'll keep the stuff everybody likes. Which is exactly what congressional Republicans are now doing. But in response, parts of the Republican base are freaking out and criticizing their fellow Republicans for saying nice things about provisions like under-26 coverage and the closing of the Medicare prescription drug "doughnut hole," both of which have already taken effect.

But do they really need to worry? Is there really a possibility that Republicans in Congress are going to boldly move forward with actual legislation that would restrain insurers and give benefits to people? Come on.

It's kabuki. Congressional Republicans need to look as though they care about health care, so they'll say they support the provisions of the ACA that are the most popular. But once the issue fades from the headlines—a week or so after the Supreme Court's decision, probably—they'll stop pretending they give a damn as we go back to the miserable status quo ante and the discussion turns back to the economy. Of course, the outrage from the right could be feigned, too. Perhaps the hard-core conservatives know that congressional Republicans aren't really going to do anything on health care, but they just want them to remember that should they seriously contemplate it, the right's vengeful wrath will rain down upon them.

And as for Mitt Romney, if I were a base conservative I wouldn't worry too much about him either. Since he once committed the unpardonable sin of enacting a popular, effective universal-coverage law in Massachusetts, he knows that he has little room to move on the issue lest he antagonize his base. His "plan" on health care is a collection of meaningless bromides ("ensure flexibility") and spectacularly bad ideas (like block-granting Medicaid, which would likely mean millions of poor Americans would lose coverage), none of which I imagine he'll have a particularly strong desire to actually act on should he become president.

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