Health Reform Takes Time

After reviewing the exceptionally ragged, slow-motion riot of Republican activity in the vague direction of a response to a possible SCOTUS decision in King v. Burwell invalidating health insurance purchasing subsidies in at least 34 states, Jonathan Cohn makes this mordant observation based on his outstanding health care policy journalism in the recent past:

[T]here’s a reason that congressional Democrats spent literally years holding hearings on health care reform and then, in 2009, focusing intensely on legislation for several months. The hearings were sometimes acrimonious and, for reform advocates, the media coverage that testimony and questions generated was a source of never-ending grief. At the same time, these hearings, before the committees that actually had jurisdiction on the issues, were necessary to craft a solution that could accomplish the reform’s main goals and then rally enough support to make it through Congress.

The kinds of plans Republicans seem to have in mind would require making equally difficult trade-offs and uniting even more fractious groups. [Ron] Johnson’s bill, for example, would limit enrollment in plans only to those who already have them, and it would eliminate the individual mandate — the requirement that people get coverage or pay a fine — in all of the states. That would force insurers to raise premiums or maybe exit markets altogether.

Other Republicans have discussed altering the Affordable Care Act’s regulation on premiums, so that insurers could charge less to younger people. But reducing premiums for the young means raising them for the old, which might be hard for Republicans to pull off given that older voters are now their political base.

Meanwhile, the mere thought of extending Obamacare subsidies — in any form, even temporarily — will run into opposition from more conservative Republicans, particularly those in the House, who want a repeal and nothing more.

In the strange revisionist history of the GOP and the conservative movement, of course, Obamacare did not take years to develop and enact: it was secretly put together in some satanic mill in Scandanavia or somewhere and then “rammed through” Congress sight unseen, with the blinding speed of a totalitarian deception.

Maybe that’s why Republicans think they still have plenty of time to come up with a Plan B. Unless, as Cohn ultimately suggests, they don’t really care:

[T]he absence of a public effort to match the public rhetoric matters only if Republicans are actually serious about passing a plan. They may not be. Their real goals may be purely cosmetic — to insulate the party from a political backlash should millions of people suddenly lose health insurance and, more immediately, to ease the anxiety of Chief Justice John Roberts and Associate Justice Anthony Kennedy, either of whom might hesitate to issue a ruling with such potentially devastating consequences to so many people.

The lack of hearings obviously doesn’t prove that Republican leaders have such ulterior, cynical motives. But it makes that theory a lot more plausible.

Sure does.

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.