The American people reject the core principles of the Republican Party’s health-care agenda — even if one defines “the American people” as the Republican electorate.
The GOP’s elected officials are committed to reducing federal spending on health care, rolling back the ACA’s Medicaid expansion, and empowering insurance companies to price cancer patients out of the market for chemotherapy — because they believe that ensuring universal access to basic medical care is less important than maximizing the economic liberty of corporations and wealthy individuals. Most GOP voters, like the public writ large, disagree on each and every one of those counts.
And yet, if voters have no interest in the meat of the Republican health-care agenda, there is some evidence that they have a taste for its side dishes. Last June, 70 percent of survey respondents told the Kaiser Family Foundation that they supported allowing states to impose work requirements on people “in order [for them] to get health insurance through Medicaid.”
That same poll found less than a third of voters supported cutting Medicaid funding. But the American electorate’s deep-seated veneration of work appeared to offer Republicans a Trojan horse for such cuts: Increasing the amount of paperwork that Medicaid applicants must complete to secure coverage would reduce participation in the program, and thus, public spending on it. The Trump White House gave red states its blessing to experiment with this strategy last year, and many Republican governors sped through that green light. Wisconsin’s Scott Walker appeared to be one of them.
Walker asked the Trump administration to sign off on Medicaid reforms more draconian than any in the country; even Seema Verma refused to let the Badger State drug-test its Medicaid applicants. Still, the White House approved the bulk of Walker’s requests weeks ago — and yet, the governor has declined to implement his (ostensibly popular) plan to make it harder for the poor to get basic medical care until after Election Day. As Politico reports:
“Wisconsin’s been stalling,” said one official, adding the Trump administration has been ready to formally approve and announce the state’s new work requirements for weeks. “It’s ended up being a lot of hurry-up-and-wait.”
… The calculus is that focusing voters’ attentions on health care in a year when Republicans are playing defense on the issue is likely to hurt Walker with independent voters who are expected to decide the election. The two-term governor is effectively tied with or trailing Democratic candidate Tony Evers in multiple polls ahead of the Nov. 6 election.
Walker’s strategic retreat reflects the fact that not all “popular” policy proposals are created equal. Requiring Medicaid recipients to work might strike voters as sensible, when pollsters run that notion by them. But very few Americans are more troubled by the thought of unemployed diabetics living high off government insulin, than by the prospect that rising health-care costs will force them to dip into their children’s college funds, or move into a cheaper apartment, or forgo much-needed medical treatment.
One way you can tell that voters have no deep investment in the work requirement issue: If you phrase the idea in slightly different terms, a majority of Americans oppose it. Earlier this year, the Center for American Progress commissioned a poll that asked voters whether states should be allowed “to deny Medicaid health coverage to recipients ages 18 to 64 who do not have a job with a certain amount of hours and do not participate in state-approved work programs” — and 57 percent said no.
By slow-walking his Medicaid requirements, Walker has tacitly admitted that the policy has less appeal than polls tend to suggest. At the very least, the governor recognizes that the issue is far less salient to the public than other health-care policy questions — specifically, than the questions that his party prefers not to answer — and thus, his best bet is to avoid a health-care debate of any kind, until all the ballots are counted, and his place in the governor’s mansion is secured.
All across the country, Republican candidates are evincing a similar recognition. Virtually no GOP politicians are campaigning on their substantive goals for health-care policy; in fact, many are campaigning against them.
The Republican candidates for Senate in West Virginia and Missouri are parties to a lawsuit that calls on the judiciary to strike down the Affordable Care Act’s protections for people with preexisting conditions. And yet, both are campaigning on their stalwart support for such protections. The congressional GOP has offered them cover, by publicizing an Obamacare replacement bill that would require insurers to offer coverage to everyone, no matter their medical history. The catch: The bill places no restriction on how much companies can charge people with preexisting conditions for their insurance. Which is to say, it guarantees that diabetics and cancer patients will have access to health insurance, in the same sense that Lamborghini dealerships guarantee them access to luxury sports cars. The bill, in its majestic equality, allows the rich as well as the poor to purchase insurance for their chronic medical conditions at $1,000,000 a month.
The basic problem confronting Walker, and all other Republicans on the ballot this fall, is that the conservative movement’s ideological commitments — and the public moral intuitions about health-care policy — are fundamentally irreconcilable. Most Americans believe that, in the wealthiest country in human history, people should not die because they cannot afford life-saving medical care. But the invisible hand will never lead insurers to provide affordable coverage to working-class people with expensive medical problems. Thus, the costs of caring for the non-affluent sick must be socialized — either through regulatory requirements that force the healthy to pay inflated premiums (thereby allowing insurers to retain profitability while underpricing coverage for the conspicuously ill), or else by having the state provide universal coverage, funded by progressive taxation. And the Koch Network exists to oppose such “collectivism” no matter the form.
Republicans have tried to resolve this problem by wildly misrepresenting their primary goals for health-care policy — and/or, recasting the health-care debate as a referendum on welfare moochers. The Democrats’ resilient polling advantage on health-care policy suggests that the former isn’t fooling very many outside the GOP tent, while Walker’s retreat on Medicaid work requirements illustrates the limits of the latter gambit.
None of this means that the GOP won’t ultimately win the war over health-care policy. A combination of bald-faced lies, culture war demagogy, the House’s gerrymandered map, and the Senate’s malapportionment, might just enable Republicans to retain power this November. Then, with Election Day safely in the rearview mirror, they can use the deficits they engineered as an excuse for gutting Medicaid, or else, simply wait for Trump’s hand-picked judges to slash the safety net by judicial fiat.
Republicans know many of their ideological goals cannot be realized in a functioning democracy. And they have no interest in changing their ideological goals.