ACA Repeal Is Forcing Republicans to Choose Between Conservatism and Compassion

“Are we the baddies?” Photo: Win McNamee/Getty Images

These days, congressional Republicans can’t go to a CNN town hall without some sickly citizen asking them, in so many words, “Are you going to kill me?”

It happened to Paul Ryan, last month, and to Ted Cruz, last night. In each instance, the legislator assured an American with a curable cancer — whose life had been saved by the Affordable Care Act — that the GOP would never abandon those with preexisting conditions to their fates. But all the ensuing rhetoric about “choice” and “access” couldn’t cover up the queasy subtext of these encounters: If Ryan and Cruz had had their way, they wouldn’t have to answer these questions, because the questioners would be dead.

To say that Obamacare saved your life is to say that Paul Ryan tried to kill you. When given the choice between maintaining a status quo that would have condemned Jeff Jeans to death — or a health-care law that raised taxes on the rich — every congressional Republican, in 2009, chose the former. In truth, “Are you going to kill me?” is a softball — the real question is, “Why did you try to end my life?”

Ryan and Cruz both managed to evade that question, explicitly. But the GOP’s deliberations over an Obamacare repeal are haunted by the political untenability of the answer: “The ideological tenets of movement conservatism were more important to us than your survival.”

Now that a Republican president is in the White House, the congressional GOP has lost the courage of this conviction. Publicly, Ryan and company promise that people with preexisting conditions — who are currently covered under the ACA — will retain their insurance, so long as they maintain continuous coverage.

This pledge is considerably less humane than Republicans make it sound. For one, by itself, this commitment does nothing for those who have yet to develop preexisting conditions, but will in the future. For another, maintaining continuous coverage isn’t as easy as it sounds: If you lose your job — and can no longer afford to pay your premiums — then insurers will once again be free to deny you coverage.

Nonetheless, Republicans are finding it difficult to make good on even this meager promise, as Politico reports:

As the GOP weighs elements of a repeal-replace plan, one of lawmakers’ biggest headaches is finding another way to persuade insurers to cover people with pre-existing health care problems. And all of the options under discussion would either raise the uninsured population or run afoul of GOP principles.

Barring insurers from discriminating against people with medical problems as long as they remain enrolled is harder than it looks and likely to leave a large pool of people uncovered — an increasingly unpalatable prospect after top Republicans from President Donald Trump on down have vowed not to push people off their coverage. Levying penalties on those who enroll late looks suspiciously like Obamacare’s existing tax penalty. And automatically enrolling people, which is part of one GOP replacement plan, strikes some conservatives as an unacceptable big government intrusion on individual freedom.

In most debates about social welfare, Republicans can tell a coherent story about why the conservative solution does not, in truth, amount to “let the weak suffer.”

They can frame cutting food assistance to the indigent as a tough-love measure — one that will help the poor develop the skills of self-sufficiency. They can claim that requiring employers to provide family leave (and other benefits) will ultimately hurt American workers, by reducing hiring. And even on health care, before the ACA was passed, conservatives could plausibly tell an American audience that government intervention would cost lives, not save them.

But now those who were saved by “big government” are standing in front of them; calling their offices; filling their town halls. And the truth about what conservatism demands can no longer be denied.

A for-profit insurance industry will never provide affordable coverage to the already sick, absent government intervention to force the healthy onto their rolls. You simply cannot have a humane health-care system without socializing risk: The rich and healthy subsidize the treatment of the poor and sick, or else the latter die preventable deaths.

And it’s a lot harder to blame the ill for their lot than it is to blame the unemployed — there’s no plausible story to tell about how all the cancer patients would get better if the government just stopped coddling them. This is why every other major conservative party in the Western world has accepted that regulating health care is a legitimate government function.

For Republicans, the choice on Obamacare is conservatism or compassion; collectivism or barbarism; to moderate their fanatical ideology, or sacrifice their most vulnerable constituents on its altar.

ACA Repeal Forces GOP to Choose Conservatism or Compassion