Kamis, 02 Januari 2014

Is This the Year of Republican Health Reforms?

On Jan. 1, the moment arrived that conservatives had been dreading: Obamacare took effect. Last year’s Republican freakout and government shutdown was a desperate, doomed, Hail Mary attempt to stave this off. It failed, and now a number of important changes have taken place: Insurance companies can’t deny coverage to people with pre-existing conditions or charge them higher rates. There’s a limit to how much they can charge the elderly. Kids can stay on their parents’ insurance until age 26. Millions of people—nobody’s sure yet how many millions—now have health insurance because of Obamacare. This unalterably changes the political landscape, even if a lot of Republicans haven’t yet come to terms with that fact.

One reason so many Republicans fought so bitterly against the health-care law and its implementation was the recognition that once a social benefit or government guarantee is bestowed, it’s almost impossible to revoke. Republicans made two big strategic bets about stopping Obamacare, both of which failed. The first was the decision not to participate in shaping the policy—the choice to oppose and obstruct the bill at every turn in hopes of killing it, rather than steer it in a more conservative direction. As former George W. Bush speechwriter David Frum noted at the time (in a column that cost him his job at the American Enterprise Institute and basically got him drummed out of the conservative movement), this turned out to be a disastrous decision—a Republican “Waterloo,” in Frum’s famous phrase.

The second big strategic bet was that Obamacare could still be stopped, even after it was signed into law, by stopping Obama himself from winning a second term. If Obama lost his bid for reelection, this line of thinking went, then his signature policy would come to be seen as a failure that cost him the White House and thus irredeemably tainted. Then it could be repealed or drastically scaled back. That’s why Republican Senate Minority Leader Mitch McConnell said in 2010, after Obamacare was law, that the “single most important thing we want to achieve is for President Obama to be a one-term president.” It’s why McConnell made himself the architect of the Republican strategy to achieve this—but that strategy ultimately failed.

Now that the law and its full range of benefits have taken effect, the idea that it can be repealed is folly. But conservatives such as the ones behind this new ad from the YG Network (“YG” stands for “young guns”), a 501c(4), seem not to recognize this new reality:

The ad simply dumps on the law, suggesting that it’s terrible and unfair—but despite the YG Network’s claim to support “conservative center-right policies,” doesn’t offer any alternatives. The fact is that even if Republicans win the White House and both chambers of Congress in 2016, they won’t dare strip benefits from what, by that point, will probably be upward of 10 million people. The best they can hope for is to be able to change the law in a way that’s more amenable to conservative ideals, as Frum was counseling them to do four years ago. What changed on Jan. 1 is that the “repeal” crowd became obsolete. The new coin of the realm for conservatives is coming up with a viable-seeming alternative to Obamacare that allows for the reality that Republicans are never going to strip millions of people of their health insurance. That’s what matters now.

Ironically, this is harder than ever for most Republicans to see, because the short-term effect of the law has been terrible for Democrats, and for Obama in particular, owing mainly to the debacle of the federal exchange website rollout, but also to ongoing problems of cost and narrower provider networks. The likelihood that Obamacare’s woes boost the odds that Republicans can win back the Senate in November will only add to the difficulty of accepting how much things changed on Jan. 1. But they have changed, so Republicans must pass through what the Washington Post’s Greg Sargent calls the “stages of Obamacare acceptance.” Unless and until they coalesce around an alternative, Obamacare is secure from their attacks.

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