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The GOP’s Real Obamacare Fear

Posted by John McDonough  July 28, 2013 10:22 AM

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How should we view the continuing efforts by Republicans to prevent the Affordable Care Act from taking effect, potentially preventing tens of millions of uninsured Americans from receiving health insurance beginning next January 1? Two explanations come to mind:

I. Republicans are acting on their sincere, policy-motivated fear that the ACA will be a "train wreck" for the U.S. health care system and the nation;

II. Republicans are acting on a politically motivated fear that the ACA will be implemented successfully, thus proving their four years of dire warnings wrong.

Since 2009, Republicans had three unambiguous opportunities to kill health reform: First, when Democrats lost a 60-seat Senate majority with Scott Brown's election win in January 2010. Second, when the U.S. Supreme Court heard arguments challenging the ACA's constitutionality. Third, when Barack Obama faced re-election in November 2012. Three at-bats and three strikes. You're out in baseball, but not this crowd.

So what's up now?

Now, Senate and House Republicans are threatening to block all continuing federal spending past September 30th -- shutting down the federal government -- and preventing an increase in the federal debt ceiling unless such moves are accompanied by repeal of the ACA.

According to Politico, Sen. Richard Burr (R-N.C.) called the push the "dumbest idea" he had ever heard. "Defunding the Affordable Care Act is not achievable by shutting down the federal government," Burr said. "At some point, you're going to open the federal government back up, and Barack Obama is going to be president." Three Republican Senators, John Cornyn of Texas, Roger Wicker of Mississippi, and Mark Kirk of Illinois all removed their names from a letter supporting the strategy after initially signing on. Senator Tom Coburn (R-OK) said: "It's a denial of reality mixed with a whole bunch of hype to promote groups and individuals who are saying, "I'm going to give you hope? for something that we can't do."

According to TPM, House Deputy Majority Whip Tom Cole (R-OK) was the most blunt:

"Seems to me there's appropriate ways to deal with the law, but shutting down the government to get your way over an unrelated piece of legislation is political equivalent of throwing a temper tantrum. It's just not helpful. And it is the sort of thing that creates a backlash and could cost the Republicans the majority in the House, which is after all the last line of defense against the president. And it could materially undercut the ability of the Republicans in the Senate to have the majority in 2014 which they have a decent chance to do."

In the Atlantic, Norm Ornstein of the American Enterprise Institute calls the proposed tactic "unprecedented and contemptible":

" do everything possible to undercut and destroy its implementation -- which in this case means finding ways to deny coverage to many who lack any health insurance; to keep millions who might be able to get better and cheaper coverage in the dark about their new options; to create disruption for the health providers who are trying to implement the law, including insurers, hospitals, and physicians; to threaten the even greater disruption via a government shutdown or breach of the debt limit in order to blackmail the president into abandoning the law; and to hope to benefit politically from all the resulting turmoil -- is simply unacceptable, even contemptible. One might expect this kind of behavior from a few grenade-throwing firebrands. That the effort is spearheaded by the Republican leaders of the House and Senate -- even if Speaker John Boehner is motivated by fear of his caucus, and McConnell and Cornyn by fear of Kentucky and Texas Republican activists -- takes one's breath away."

So here is my question:

If ACA implementation will be the "train wreck" that Republicans predict, they have an obvious strategy to kill it: let it go into effect so that the entire nation will see how bad it is. Do nothing to impede -- or to be seen to impede -- implementation.

There is precedent for major health reform laws crashing in implementation -- most notably the 1988 Medicare Catastrophic Coverage law, signed by President Ronald Reagan and repealed by President George H. W. Bush 18 months later in 1989. New Hampshire, Kentucky, Washington, all passed bold health reform laws in the 1990s (including guaranteed issue, a key ACA insurance reform) and repealed all or major components once people in those states experienced implementation. Plenty of precedents exist for ignominious embarrassment by legislative sponsors followed by fast repeal.

Also, if the law were not to take effect now, many would claim it was destroyed by politics and never given the chance to work. Letting the law go into full, robust effect would remove any doubts. Case closed, and Democrats likely would suffer ignominious defeats in 2014 and maybe 2016 as a result.

So, we know what's up. Republicans don't fear that the ACA won't work; they fear that it will work. They are scared that their four years of constant fear mongering about death panels and rationing is about to be fully exposed as one of the greatest political frauds in U.S. history.

If they believe their own rhetoric, this is the moment to wait, watch the wreckage, say "I told you so," and reap the political rewards.

They won't and they can't, because it's explanation II that is in play here.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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