The Republicans’ scorched-earth approach to health coverage, which might be paraphrased as “you’ll see a doctor over my dead body,” is looking more and more ludicrous as time goes on. The turning point, I think, was the beginning of 2014. Millions of people, I forget how many, had health coverage for the first time in years, or the first time ever. Analysts and politicians had worried aloud about a tsunami of doctor and hospital visits among the newly insured that could break the whole health care system. Some serious predictions held that the number of doctor visits and treatments could double for a month or two. Instead, the boost in visits in the first week was so slight it was detectable only by careful statistical analysis. Letting more people have access to health care hasn’t broken anything yet, and there are hardly any more major transitions ahead under the law. Given its history of relative success, the guarantee of health coverage for freelancers and unemployed workers is as popular among Republican voters as it is among everyone else.
The latest conundrum for House Republicans is the cynically named Save American Workers Act which would exempt many employers from providing health coverage by allowing them to categorize their full-time workers as part-timers while still having them work full-time. This loophole would result in a million workers losing health benefits, according to CBO estimates. It would eliminate thousands of jobs and put half a million more people into the ACA plans that the Republicans are trying to do away with. Another loophole in the bill would cost the government about $8 billion a year in revenue by allowing businesses to dodge taxes. The bill is sponsored by essentially the entire House Republican caucus, who now must decide whether they can vote for a bill that boosts the government deficit and enrolls more people in the government-managed health care exchanges they claim to oppose. The alternative is to vote against a bill they sponsored in the first place. Either way, it looks bad.
And it won’t get any easier for the Republicans. They can’t openly threaten to cancel health coverage, now that people actually have it. That stance could cost them the votes of many Republicans, who would rather hold their noses and vote for Democrats than say goodbye to their family doctors. So Republican are reduced to trying to offer an “alternative plan” or an “improvement.” But there is an obvious double-bind there. If the Republican alternative is an actual improvement in letting people get health care, it is the opposite of what the Republicans are trying to do, which is to reduce access. Worse in a political sense, it would mean conceding that the current laws, which they were willing to destroy the country to repeal, were essentially right in the first place. But if the Republican alternative takes away people’s health care, it will be politically unpopular. Probably the only politically survivable approach Republicans can take at this point is to do nothing, but of course, they are being pilloried as do-nothings for their record of the past nine years, so that approach has its political costs too.
Some of the Republicans saw this problem coming, and that is one reason why they were so adamant about shutting down the federal government for 14 months, from last October through this year’s elections, to try to prevent the health insurance exchanges from launching. But Republicans so disagreed about that strategy that it led a dozen of them to decide to retire after this year’s elections. In truth, it was already too late. They might as well have formed picket lines in front of every clinic and hospital with signs reading, “Medical care unfair to billionaires.” It is a small contingent of the super-rich who want to keep workers off-balance by keeping them perpetually sick, and the Republicans have agreed, for reasons I will let you work out, to do the bidding of this group. Yet it is an issue that, at this point, they cannot win.
