As Trump and Ryan desperately try to convince hard-right Republicans to kill Obamacare on its seventh birthday, the obvious question is why are the leaders of the anti-Obamacare movement the biggest block to repealing it? The answer is the potent mix of partisanship and ideology that has driven Republican politics for the past 25 years.
In 1993, then House Minority Leader Newt Gingrich adopted the advice of William Kristol to defeat any health care measure proposed by President Clinton as “… a model for routing contemporary liberalism and advancing an aggressive conservative, activist agenda.” Gingrich, with the backing of the health insurance industry in their “Harry and Louise” ads, argued against “mandatory government health alliances” and “bureaucrats.” When Gingrich captured the House with fifty-two seats flipping from Democrat to Republican, the Kristol strategy was vindicated.
Fast forward to 2006, when Massachusetts advocates for the government making health care affordable to all joined with hospitals and health insurers – both of which are non-profit in Massachusetts – to devise a health plan that combined conservative and liberal policies. Republican Governor Mitt Romney and the Democratically controlled State Legislature turned the plan into law. The basic structure of the Massachusetts law – an individual mandate to purchase private health coverage through a market (conservative) along with expanding public programs and subsidizing the purchase of a regulated insurance market (liberal) – became the foundation for the Affordable Care Act.
But rather than follow the Massachusetts example, Republicans in Congress took a page from the Gingrich playbook and opposed any health care legislation proposed by President Obama. Over the two decades since Gingrich became House Speaker, Republicans had heightened their opposition to regulation of business and to government social insurance and anti-poverty programs. The power of conservative think-tanks, political operations and media relentlessly pushed the GOP to the right on policy and on politics. Their litmus test became no cooperation with Democrats on any expansion of government outside of the military.
In the Senate, a handful of Republicans spent the summer of 2009 working with the Senate Finance Committee Chairman, Democrat Max Baucus, to write legislation that might be acceptable to both parties. But even as Baucus made a number of policy concessions to his GOP colleagues – virtually all of which were included in the final legislation – the Tea Party eruption in August scared away the few Republicans open to a bi-partisan agreement.
The Tea Party was the fulfillment of the conservative project, convincing a sizeable minority of Americans that no matter what it did, government was bad. The cry to “keep government out of my Medicare” became the symbol how a relentless ideologically driven narrative could blind people to reality. Conservatives employed a sizeable dose of coded-racism to attract middle class Whites who had lost both status and financial security, by framing government programs as helping the (Black and immigrant) poor at their expense.
So when Democrats stood up to the Tea Party and passed the Affordable Care Act, it shocked the right. It was their nightmare come true, the biggest expansion of government since the Great Society. Conservatives recognized that if the health coverage expansions in the law actually were implemented, so many Americans would benefit it would be politically impossible to reverse course. They made repealing the law their signature issue and tried everything they could do in the courts and legislature to stop the ACA from being implemented. But in 2012, with the Supreme Court’s affirmation of most of the law and the re-election of President Obama, they had lost.
Still, they didn’t give up the fight, relentlessly campaigning to repeal Obamacare until –surprise! – they got the chance. The chance to learn that no matter what they do, they’d lost the ideological fight.
The GOP health bill keeps government subsidies for health coverage because the political cost of ending them fully is clearly too great. It rolls back Medicaid, but falls short of the radical proposal to shift Medicaid to the states, which is adamantly opposed by Republican governors and by hospitals. The Republican proposal preserves key insurance protections, like the prohibition against denying people coverage for a pre-existing condition. Even still, the fear that 24 million Americans will have their coverage taken away has made the ACA more popular with the public than since its passage.
The GOP’s adamant partisanship is also coming home to roost, as Democrats learned the power of pure opposition. Those Democrats who might have considered cooperating with Republicans have been warned off by a wave of grassroots activism that is larger – and more spontaneous – than any the Tea Party mustered.
Which brings us to the great irony of the hard-right Freedom Caucus being the biggest obstacle standing in the way of Trump and the Congressional leadership. The most stalwart crusaders for repealing Obamacare are correct when they call the Republican legislation “Obamacare-lite.” Even as the law would be disastrous for millions of American families and communities, it leaves many of the basic structures of the ACA in place. It would not take a wholesale rewriting of the health law for Democrats to reverse these changes if they had the power to do so.
Republicans face a political disaster of their own making. If they manage to pass some version of repeal and replace, they will face a backlash from Americans who have lost coverage and will assume blame for hikes in health care costs. If they fail, they will still face a public aroused by their attempt. Plus they will also confront the anger and disillusionment of a right-wing base created by their story that government is a threat to their liberty.
Regardless of the outcome, the challenge and opportunity for Democrats is to seize the moment to tell a positive story about the role of government, backed up by policies that deliver on that story. Democrats must explain that this shows only government can provide the security of affordable health coverage.
They must promise that if they have the opportunity to govern, they will use government to take on the for-profit insurance and drug corporations. To guarantee affordable coverage, including by offering everyone a choice of Medicare, our national health insurance program for seniors. And using the public’s purchasing power to force down prescription prices. By doing so, Democrats can use the Republican’s disastrous partisan, ideological crusade to lay the ground work and agenda for a new progressive era.