By now, Republicans are surely tired of talking about health care. After all, as policy areas go, it really isn't their thing. Ask them about tax reform and they're happy to talk for hours about all their ideas to free job creators from the unfair burden of taxation, but health care? Dullsville, as far as they're concerned. And they've had to talk about it for years now, with no end in sight.
It's a problem of their own making, of course. When the Affordable Care Act passed in 2010, they could have said, "We don't like this, but now that it's the law, we'll propose our own reforms that could be passed in the future." But that would have required that they actually come up with conservative health care ideas and form a party consensus around them. That's what Democrats did over the decade and a half after Bill Clinton's reform died, but Republicans just weren't all that interested in the policy. So instead, they went on a holy war against the ACA, one that is unprecedented in American history. There have been laws that were litigated and fought over after their passage, but there has never been anything quite like this, with not only a parade of lawsuits but a sustained public campaign with hundreds of millions of dollars spent to tear down the law and one Republican legislature after another practically standing in the hospital door to try to keep people from gaining its benefits.
We've reached a point today where hatred of the ACA-not just opposition, but visceral, passionate, encompassing hatred-has become a defining foundation of Republicanism, no less important than a commitment to low taxes and small government. There are Republicans who believe in an expansionist foreign policy and those who believe America shouldn't get involved in foreign conflicts, and Republicans who believe in opposing same-sex marriage and supporting same-sex marriage. But there is no Republican anywhere who won't say that he or she hates, hates, hates Obamacare.
But here's where things get complicated: The intensity of that opposition has almost nothing to do with the law's actual provisions. Consider that last week, when a group of Republican senators finally unveiled a plan to replace the ACA, they didn't even bother to come up with a bunch of free-market reforms that would supposedly bring about universal and affordable coverage through the magic of the invisible hand. What they offered instead was basically a version of the ACA that's a little more stingy. They accepted most of the law's means and ends but trimmed them back: There would be subsidies to buy insurance (government handouts!), they'd just be worth less; there would be some protection against insurance company denials for pre-existing conditions (government regulations!), but that protection wouldn't be as complete; the restrictions on what insurance companies can charge would be there (more regulations!), but they'd be loosened, and so on.
If the ACA is socialism, this GOP plan would be socialism with a less humane face.
Meanwhile, Republicans in the states continue to agonize over whether they should accept the spectacular deal that is the law's expansion of Medicaid. Last week, legislatures in Tennessee and Wyoming rejected plans their Republican governors had negotiated with the federal government to accept the expansion; it was a reversal of the pattern in recent months, in which one Republican state after another had decided to take the money and do the right thing. Tennessee's rejection came after an intense campaign against expansion conducted by Americans for Prosperity, the main political outlet for Charles and David Koch.
Yes, it's an amazing spectacle: The federal government has to bend over backward to convince these states to take billions of dollars in free money to insure their poor citizens, as though the states were doing the feds some enormous favor. But the most notable thing may be that nearly five years after the law's passage, so many Republican states are still torn over whether to sign on. State-level Republican politicians want what the law offers, but don't want to give Barack Obama the satisfaction of seeing them give health insurance to poor people.
Meanwhile, the King v. Burwell case, which if it were successful would take insurance subsidies away from millions of middle-class Americans, will be heard by the Supreme Court in a matter of months. Though the plaintiffs' effort to gut the law has the support of what appears to be every elected Republican in America (if there are any who oppose the suit, they haven't made themselves known), Republicans are being gripped by ambivalence here too, as they suddenly realize that if the lawsuit succeeds, it would be a political disaster for them. No doubt imagining the news dominated by story after story of people losing the help that allows them to afford insurance, they're whipping their heads around looking for someone to blame.
And in an act of truly spectacular chutzpah, some are now complaining that the Obama administration isn't adequately prepared to help those who would lose their subsidies if the Republican lawsuit is successful. "The administration has done absolutely nothing to prepare for an upcoming Supreme Court decision that could leave millions of Americans unable to afford insurance thanks to this failed law," said Senator Ted Cruz. You read that right: Ted Cruz is outraged about the prospect of millions of Americans being unable to afford health insurance if a lawsuit that he supports prevails.
It's possible that once Barack Obama leaves office in 23 months-and presuming the law survives King v. Burwell, which it might not-some of the urgency Republicans feel for the cause of restoring health insecurity to America will dissipate. Perhaps then they'll return to the former state of their feelings about health care-not just bored by the policy details (which they still are), but completely disinterested in the issue as a whole. America should be so lucky.
