Fine Old Cannibals

Last week I wrote about the cynical maneuever by House Republicans to exhibit compassion for those being denied health insurance due to pre-existing conditions by shifting money into an underfunded temporary high-risk pool set up by the Affordable Care Act, noting that the Club For Growth was attacking the bill as wasteful and insufficiently deferential to the pathetic efforts of the states in this area. The bill is scheduled for a vote in the House today.

The true measure of this gambit is provided by one of its supporters, FreedomWorks, whose vice president for public policy, Dean Clancy, sent out an open missive on the subject:

Next week, the House may take up a bill (H.R.1549, the Helping Sick Americans Now Act), which has been purported to “fix” a part of ObamaCare, and some conservatives are crying foul.

I think those conservatives are misguided.

They should support the bill, or at least not oppose it….

Contrary to the assertions of some, H.R.1549 doesn’t “fix,” “expand,” or otherwise “improve” ObamaCare. Instead, it effectively cannibalizes ObamaCare to impede its implementation. The bill would transfer $4,000,000,000 (four billion dollars) from an ObamaCare implementation slush fund to a program called the Pre-Existing Condition Plan, or PCIP). The slush fund is a big pot of money the Administration is using to set up exchanges in states that refuse to set them up (a resistance we’ve strongly encouraged). The PCIP is a subsidy for sick people, to help them obtain private health insurance coverage. PCIP is a federal version of the high-risk pool (or as I prefer to call it, preexisting-conditions or preex pool) subsidy that is employed in more than half the states to help private insurance markets work better. Democrats included PCIP in their ObamaCare takeover as a temporary bridge to the new system, which takes full effect on January 1st, 2014. In doing so, the Democrats were implicitly admitting that preex pools are a practical way to help the one percent of Americans who simply can’t access affordable health insurance due to a preexisting medical condition. PCIP is not, in itself, a good program. But if Congress had enacted only PCIP in 2010, instead of ObamaCare, America would be in a much, much better place today.

Now, I agree with those conservatives who hold that preex pool programs should be state- rather than federally run. But the harm here is slight, because PCIP is scheduled to expire on December 31st of this year. It’s a temporary subsidy, remember.

H.R.1549 should be viewed as a tactical maneuver in a larger war, cannibalizing the implementation of ObamaCare exchanges in order to gain leverage in the larger fight for health care freedom.

Pretty plain, eh? Give sick people without insurance temporary access to crappy private plans at exorbitant rates as part of a strategy aimed at pulling the rug out from under them entirely at the end of the year, all the while mewling about one’s concern for sick people.

It makes me sick.

UPDATE: After a closed meeting today, House Republican may pull this bill from the calendar due to conservative opposition to doing anything that might be perceived as “fixing” Obamacare or asserting government responsibility for the uninsured.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.