Republicans clearly don’t like the President’s landmark health care law, but they aren’t going to come up with anything to replace it with any time soon.
The big political news this week was of course president Obama’s State of the Union address from Tuesday night. Pundits and media types love to parse these sorts of things so feel free rate it if you want, but one of the strangest moments of the whole night had to happen during the Republican response given by Iowa Senator Joni Ernst. During her speech Ernst rolled out the standard Republican line on health care, “We’ll also keep fighting to repeal and replace a health care law that’s hurt so many hard working families.”
As Jonathan Bernsterin put it, “Sometimes you just have to be in awe of the chutzpah.”
Why chutzpah? Well because as Bernstein points out Republicans never offered an alternative bill during the 14 months it took to draft and pass the Affordable Care Act and never got around to offering their “replace” part of repeal and replace in the almost five years since then.
In short Republican legislators know they hate Obamacare, but they have no idea what to replace it with.
This isn’t because Republicans are dumb or anything, there are plenty of smart Republican wonks and policy experts that have purposed alternatives over the years, rather it’s because the the incentives just aren’t there for Republicans to actually do the tough work required for drafting alternative legislation.
Vox’s Ezra Klein pointed this out last week in a lengthly article, but the really important part of the argument basically boils down to this:
The problem for conservatives is that making sure poor people have health insurance is politically popular, at least in the abstract. But the plans that achieve it tend to be in tension with both broad tenets of conservatism—it raises taxes, it redistributes wealth, and it grows the government—and with key factions of the conservative coalition…
…But in exploring those Obamacare alternatives, [conservative author Philip] Klein illuminates an inconvenient truth: upheaval in the health-care system typically makes for terrible politics. Democrats learned that the hard way with the Affordable Care Act. Republicans would likely learn it double if they made a serious effort to repeal, replace, or overhaul Obamacare.
This is the central problem for conservative health reformers: because Republicans don’t care that much about health reform and because so much of what health reform demands offends conservative sensibilities or constituencies, the party doesn’t want to make the sacrifices necessary to unite behind an alternative to Obamacare, much less actually pass and implement it.
This of course doesn’t mean that health care policy won’t change in the future, if Republicans win unified control of government in 2016 they might cut back on some subsides or make it harder to sue a doctor that screws up. But what those changes will result in practice is not “repealing and replacing Obamacare” but simply building on the new health care system that has emerged over the last five years.
Or to put it another way, the fact that Republicans can’t develop an alternative to Obamacare is the strongest evidence out there that it really is here to stay.
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