Republicans have no affirmative case for their health-care bill. They have lies about why the bill is necessary (“Obamacare is collapsing”), lies about what it’s designed to do (reduce premiums and deductibles, and cover everyone), and lies about who would lose out from its passage (“absolutely nobody”).
But few, if any, congressional Republicans have attempted to make the case for why cutting Medicaid and insurance subsidies for the middle class — so as to fund a capital-gains tax cut for millionaires — will cure all that ails the American health-care system.
The only halfway honest argument Mitch McConnell & Co. have mustered for their plan has been a political one: We promised our base we’d repeal Obamacare, and if we fail, they will revolt.
This was the claim that, reportedly, convinced vulnerable House moderates to back a more right-wing version of Trumpcare than the one they’d initially opposed. It’s the argument that President Trump’s outside group made in its (short-lived) ad campaign pressuring Nevada senator Dean Heller to fall in line. And it’s doubtlessly a large part of the case that Mitch McConnell is making right now to the bill’s skeptics, as he struggles to salvage the embattled legislation.
In the Washington Post, Republican propagandist and MSNBC host Hugh Hewitt rendered the rationale in apocalyptic terms, writing, “The grass roots’ disgust with this betrayal will be so deep as to endanger every senator, even in deep red states such as Mississippi, Texas and Utah.”
But a new NPR/PBS NewsHour/Marist poll suggests that this simply isn’t true.
A mere 35 percent of Republicans approved of the Senate bill — in a survey taken before the CBO released the ugly score that scared McConnell’s caucus into revolt. And the legislation doesn’t just lack majority support from Republican voters, writ large, but also from the most committed supporters of the party and president.
The responses to this second question from the survey are just as telling:
Only 10 percent of Republicans want Congress to reform Obamacare into a stingier program — less than half the number that want an Obamacare replacement that “does more.” And yet, the former is precisely what Mitch McConnell and Paul Ryan are trying to do.
It’s true that 53 percent of Republicans call for full repeal, suggesting that they oppose the Senate’s bill from the right. If that were accurate, then one could argue that something like the current plan is the most politically feasible means of pushing public policy in the base’s desired direction.
But while there are certainly a good number of genuine conservative ideologues in this country, it’s doubtful that they account for the lion’s share of that 53 percent. Republican base voters have been told, over and over, that Obamacare is a synonym for everything they don’t like about the American health-care system. It’s likely that many such voters like the sound of “full repeal” — but not that of cutting Medicaid to give the rich a tax break.
In fact, recent polling suggests a good number of self-identified conservatives — if not a plurality or slim majority — oppose both those ideas.
The GOP’s messaging on health care indicates that they know this is the case. The president campaigned on a promise to preserve Medicaid in its current form and achieve universal coverage with lower deductibles. The mogul even went so far as to explicitly disavow the GOP’s historic hostility to the welfare state, telling 60 Minutes, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
But Trump hasn’t been the only one singing such a tune. Virtually all of the GOP’s leading lights have attacked Obamacare from the left, including McConnell, who lamented in January, “there are 25 million Americans who aren’t covered now … And many Americans who actually did get insurance when they did not have it before have really bad insurance that they have to pay for, and the deductibles are so high that it’s really not worth much to them.”
The bill before the Senate would increase the ranks of the uninsured by 22 million, grow deductibles, and, for many of the GOP’s elderly voters, jack up premiums. There may be reasons to vote for such legislation — but surely a commitment to keeping your word isn’t one.
Republicans have proven incapable of passing “full repeal” of Obamacare. Their options now are to do nothing; pass an “Obamacare lite” bill that few of their voters like in the abstract, or in its particulars; or work with Democrats to pass a modest set of reforms that would actually stabilize the individual market without causing their low-income supporters any pain — and then announce that they have repealed and replaced Obamacare (and, if there’s still something people don’t like about the health-care system, well, that’s just because we had to work with Democrats).
The policy case for the Senate’s health-care bill is nonexistent. The political case is baseless and incoherent: The Republican grassroots didn’t demand Obamacare lite before the election, and they aren’t demanding it now. No GOP politician in the country was elected on a promise to preserve the basic structure of Obamacare, while cutting Medicaid and the capital-gains tax rate.
If Mitch McConnell’s caucus does so, anyway, it won’t be out of loyalty to the people who vote for them, but rather to those who bankroll their campaigns.