Even before the Congressional Budget Office releases their findings on the American Health Care Act (the Republican plan to repeal/replace Obamacare), it is clear that it will be a disaster if it passes. With that said, what conservatives are demanding in terms of changes would do nothing more than make it worse.
As Rachael Bade and Kyle Cheney report today, exactly what would mollify conservatives is not clear at this point. The two main things they’ve insisted on have been to move up the date for phasing out Medicaid expansion from 2020 to this year and to completely eliminate the tax credits for those who purchase individual plans. In many ways, that would mean a return to the status quo prior to passage of the ACA. But some members actually want to go farther by including a work requirement for Medicaid recipients – which is truly draconian given that many of them are children with disabilities or elderly in nursing homes.
As Paul Krugman wrote today, the current state of repeal/replace tells us a lot about the state of the GOP.
Given the rhetoric Republicans have used over the past seven years to attack health reform, you might have expected them to do away with the whole structure of the Affordable Care Act — deregulate, de-subsidize and let the magic of the free market do its thing. This would have been devastating for the 20 million Americans who gained coverage thanks to the act, but at least it would have been ideologically consistent.
But Republican leaders weren’t willing to bite that bullet. What they came up with instead was a dog’s breakfast that conservatives are, with some justice, calling Obamacare 2.0. But a better designation would be Obamacare 0.5, because it’s a half-baked plan that accepts the logic and broad outline of the Affordable Care Act while catastrophically weakening key provisions. If enacted, the bill would almost surely lead to a death spiral of soaring premiums and collapsing coverage. Which makes you wonder, what’s the point?
In many ways, the conservative wing of the party is much more in line with the messaging we’ve seen over the last few years from Republicans. As bad as the AHCA is – it is actually a sell-out to the principles included in Obamacare.
In contemplating how the GOP managed to get themselves in a position like this, I was reminded of something Krugman wrote a while ago about their rejection of competence and embrace of ignorance.
Competent lawyers might tell you that your Muslim ban is unconstitutional; competent scientists that climate change is real; competent economists that tax cuts don’t pay for themselves; competent voting experts that there weren’t millions of illegal ballots; competent diplomats that the Iran deal makes sense, and Putin is not your friend. So competence must be excluded.
For years now the Republicans have embraced ideology over competence. Speaker Paul Ryan tries to put a wonky spin on their ideologically-based policies, and while in the minority, too many people gave him a pass. Now that his proposals are actually being considered, he is getting called out on the kind of ignorance we saw yesterday about how insurance actually works.
This embrace of ideology over competence is exactly how we’ve arrived at a post-truth era. An abandonment of facts/data coupled with emotional appeals (often based on lies) have been the tools used to promote ideology. The Republican Party remains devoid of any principles based on the pragmatism of what works. It is possible that, in their zeal, they will be able to destroy Obamacare and maybe even pass their massive tax cuts for the most wealthy among us — all while ignoring the facts about what a disaster those policies will be.
The pragmatists among us know how that story will end. Our frustration is primarily the result of having that knowledge, coupled with the risk that we won’t be able to stop them.