Republicans have spent eight years assuring the public that they, too, shared the goal of protecting people with preexisting conditions from price discrimination. Sunday, Health and Human Services secretary Tom Price tore down the tattered façade. Asked why insurers called the Republican health-care plan, which allows them to charge higher premiums to the sick than the healthy, unworkable, Price insisted they would just go back to the way things worked before Obamacare. “It’s really perplexing, especially from the insurance companies, because all they have to do is dust off how they did business before Obamacare,” he said on ABC. “A single risk pool, which is what they’re objecting to, is exactly the kind of process that was — that has been utilized for decades.”
Republican policy elites consider such an admission obvious, even banal. To the great mass of the voting public it would come as a shock. “I want to keep preexisting conditions. I think we need it. I think it’s a modern age,” promised Donald Trump during his presidential campaign. Mike Pence, delivering what the campaign billed as its seminal health-care address just a week before the election, likewise pledged, “We will protect Americans with preexisting conditions so that they are not charged more or denied coverage, just because they have been sick, so long as they have paid their premiums consistently.”
There is no mystery why Republicans made this promise. Regulations preventing insurance companies from excluding or charging higher prices to people with expensive medical needs is the single most popular feature of Obamacare. In in the darkest moments of Obamacare, Democrats have highlighted this feature, and Republicans have assured the public they would keep it in place. In January, Mitch McConnell dismissed this charge: “We already know their central contention, that Republicans somehow want to go back to the way things were before Obamacare — which, of course, everyone knows is untrue.” And yet here was Price casually admitting that going back to the way things were before Obamacare was exactly their intention.
What has brought the Republican Party to this point is a public-opinion backlash so overwhelming that the normal rules of politics cease to apply. Americans prefer Obamacare to the GOP alternative by a two-to-one margin. By nearly a three-to-one margin, Americans want the GOP to work with Democrats to repair the Affordable Care Act rather than repealing and replacing it. Even Trump voters are split evenly on this question:
It might seem obvious that Republicans should surrender to public opinion, abandon their loathed plan, and work with Democrats to fix the health-care system. Instead, they seem to be calculating that they have more to lose than to gain by fixing the health-care system, and implicitly conceding that their eight-year crusade to destroy Obamacare has been a lie. There is a logic of sorts to this position: They are on the dark side of the moon, and see their only path as going farther away.
Josh Holmes, a former high-level adviser to McConnell, tells the Washington Post that passing the Senate plan gives his party the best chance in the midterm elections. “If you can find me an election cycle where Democrats haven’t run ads accusing Republicans of throwing the poor and elderly off of health care, I’ll buy you a beer,” he argues.
It is true that Democrats have spent several decades accusing Republicans of trying to deny health insurance to the poor and sick. That is because Republicans have indeed spent several decades trying to deny health insurance to the poor and sick. As Paul Ryan said earlier this year, he has been dreaming of deep cuts to Medicaid since his kegger days. It is not a popular position by any means. But fanatical hatred of the welfare state does have a constituency among the major institutions of the conservative movement, many of which are well-funded and important to rallying base voters.
Holmes’s case seems to concede that, if Democrats are going to run against his party by pointing out that they plan to deny insurance to the old and sick, they might as well go ahead and deny insurance to the old and sick.