It’s the total CW that a Supreme Court decision invalidating the Patient Protection and Affordable Care Act, in toto or in terms of the key individual mandate provision, would be an election-year disaster for Barack Obama. While I agree such a decision would be a historic setback for progressives (both in terms of its immediate effect and of the possible implications for judicial precedents supporting other progressive accomplishments), I’ve never thought it was at all clear it would benefit the GOP electorally this year.
Most obviously, it would remove a motive for some swing voters to oppose Obama on grounds of this or that real or imagined shortcoming of “ObamaCare,” while creating a new motive for supporting him if he immediately proposes (as he would) a partial or near-total replacement. Conversely, Republicans could no longer remain vague about their own health reform “ideas,” and would be under intense pressure to do something about ObamaCare’s most popular provisions, of which Americans will become acutely aware in the massive media coverage that would follow an adverse decision by the Court.
We’ve seen the fears and conflicts among Republicans about a post-ObamaCare 2012 election cycle in the recent maneuverings over what they would do about three specific “popular provisions:” one that has already taken effect (allowing children up to the age of 26 to remain on their parents’ health insurance policies); one that is in the process of being implemented (the filling-in of the Medicare Part D “doughtnut hole” affecting middle-class families); and one that is immensely popular if often misunderstood, the prohibition of denial of health insurance coverage based on pre-existing conditions.
Conservative activists are generaly united in a “just say no” position that either endorses the health care status quo ante as more than adequate, or that promotes ancient GOP health policy pet rocks like interstate insurance sales, increased incentives for medical savings accounts, and “tort reform.” But many Republican members of Congress prefer a quick “fix” to neutralize a post-ObamaCare backlash.
This latter tendency has reemerged most recently among Senate Republicans, as reported by TPM’s Sahil Kapur:
Despite the blowback from conservatives, who want nothing less than to wipe out the law in its entirety, top Senate Republicans are signaling that they’re behind the strategy of resurrecting some aspects of the Affordable Care Act.
Sen. Roy Blunt (MO), vice chair of the Senate GOP Conference, offered a ringing defense of the “Obamacare” under-26 provision, and said he wouldn’t oppose ideas he previously supported simply because President Obama adopted them….
Sen. Lamar Alexander (TN), asked by TPM if he believes his party should back the pre-existing conditions and under-26 laws, didn’t endorse specifics but affirmed that his party ought to have a plan ready. “Well, I think we need to be prepared,” he said. “And we will be prepared.”
The problem, of course, is that the children-under-26 provision won’t make health insurance companies happy, the “doughtnut hole” fix costs real money; and the biggie, a prohibition on pre-existing condition exclusions, could boost premiums through the roof and require strenuous federal regulation of insurers–not exactly what Republicans want since they are trying to undo existing state regulation of insurers.
Roy Blunt provides a glimpse of GOP “thinking” on this last issue:
Blunt floated the idea of high-risk pools to cover pre-existing conditions — an idea that presents its own adverse-selection quandary — and discussed the broader systemic problem in remarkably similar terms as Obama and his allies have done in their defense of the Affordable Care Act’s individual mandate.
“You know, you do run a risk when you decide you’re not going to have insurance,” Blunt said. “And a lot of those — that odd, that occasional young person who believes they’re not going to need health care, doesn’t get it, and then they have a terrible accident or they have a unique illness that most young people don’t have. These high risk pools give them somewhere to go that is somewhere close to normal insurance.”
Anybody familiar with the high-risk polls currently operated by the states for people losing employer-based insurance–typically crappy insurance at extremely high rates–isn’t going to buy Blunt’s trial balloon for that “solution.” And it’s an indication of the deeper problem facing a party and an ideological movement that not only are hostile to health reform, but are fundamentally committed to a “vision” of health care that is a throwback to the 1950s.