Why the Health Care Law Scares the G.O.P.
By EDUARDO PORTER
Published: October 1, 2013
This spring, the Missouri Chamber of Commerce urged the state Legislature to accept the federal government’s plan to expand Medicaid for the poor and disabled.
The business lobbying group had not suddenly gone rogue. Here is how
Daniel P. Mehan, its president, summarized his feelings about President
Obama’s health care law: “We don’t like it.”
But the Chamber was cognizant of the plea of its members directly
affected by the issue: dozens of Missouri hospitals stood to lose $4.2
billion over six years in federal support for uncompensated care if the
state refused to increase the income ceiling for Medicaid eligibility.
Pragmatism suggested accepting the expansion. Washington would pay the extra cost entirely for three years and pick up 90 percent of the bill thereafter.
And it would expand health coverage in the state’s poor, predominantly
white rural counties, which voted consistently to put Republican
lawmakers into office.
Missouri’s Republican-controlled Legislature — heavy with Tea Party
stalwarts — rejected Medicaid’s expansion in the state anyway.
After their vote, a frustrated editorial in the faithfully conservative Missourian asked of the state’s elected Republicans: “Who Do They Represent?”
Today, the same forces that blocked the expansion of Medicaid in
Missouri are going all out in Washington in a bid to undo all of the
Affordable Care Act. Bowing to the vehemence of its Tea Party faction,
the House G.O.P. forced a government shutdown when Senate Democrats
refused to delay or defund the president’s health overhaul.
House Republicans are threatening even further damage if they don’t get
their way, possibly unleashing financial chaos if they manage to force
the United States into its first default ever on the government’s debt.
Republicans’ efforts raise the same perplexing question posed by the
Missourian: What drives Tea Party Republicans and their financial
backers? What calculation persuades them that repealing the health care
law is worth the risk? Indeed, whose interests do they represent?
Nearly 6 in 10 Americans disapprove of trying to stop the law by cutting its financing. Even among those who don’t like the law, less than half want their representatives in Congress to try to make it fail.
It is tempting to discard the Tea Party activists driving the Republican Party as crazy — as some commentators have
— motivated by fear and willing to believe that default won’t cause
much harm and might even act as a purgative to free the economy of a
bloated government.
“They listen to nobody but themselves,” the Harvard political scientist
Theda Skocpol told me. “They are convinced of their rectitude and
convinced that they alone are qualified to save America from the dire
threat of Obama and his polices. They have worked themselves into a
dangerous place.”
Their relationship with reality can take peculiar turns. Reflexive opponents of “government,” they can exhibit little sense of what the government actually does.
And yet the argument that half the Republican Party has simply lost its
mind has to be an unsatisfactory answer, especially considering the
sophistication of some of the deep-pocketed backers of the Tea Party
insurgency.
There is a plausible alternative to irrationality. Flawed though it may
turn out to be, Obamacare, as the Affordable Care Act is popularly
known, could fundamentally change the relationship between working
Americans and their government. This could pose an existential threat to
the small-government credo that has defined the G.O.P. for four
decades.
The law is imperfect. It has dozens of complicated, interlocking parts.
Half of Americans say they don’t understand how it will affect them and
their family. Still, the law has many provisions that are likely to
improve life for millions of Americans, including a big portion of what
we know as the working middle class.
Almost two-thirds of uninsured Americans have a full-time job, according to the Kaiser Family Foundation. A further 16 percent are employed part time.
The Department of Health and Human Services recently estimated
that nearly six in 10 uninsured Americans could qualify for health
coverage in the insurance market for less than $100 per person per
month.
According to an analysis by the Urban Institute,
28 million Americans would gain health insurance under Obamacare. Of
these, eight million earn more than twice the poverty level of $47,100
for a family of four. A majority of those would get a subsidy to buy a
plan.
As it turns out, the core Tea Party demographic — working white men between the ages of 45 and 64 — would do fairly well under the law.
Take Missouri. It has about 800,000 uninsured. Almost half of them would
have been eligible for expanded Medicaid benefits, had the Legislature
not rejected them. Many of the rest — including families of four making
up to $94,000 — will be eligible to get subsidized health insurance.
In St. Louis, for instance, a family of four making $50,000 a year will
be able to buy a middle-of-the-road “silver” health plan for $282 a
month and a bottom-end “bronze” plan for $32. Even Medicare recipients will get a benefit worth a few hundred dollars a year.
This could justify conservative Republicans’ greatest fears.
In 1994, when President Bill Clinton took an earlier stab at a health care overhaul, the conservative thinker William Kristol published a manifesto about why Republicans had to stop it.
“Passage of the Clinton health plan in any form would be
disastrous,” Mr. Kristol wrote, italicizing for emphasis. “It would
guarantee an unprecedented federal intrusion into the American economy.
Its success would signal the rebirth of centralized welfare-state policy
at the moment that such policy is being perceived as a failure in other
areas.”
Two decades after Mr. Clinton’s ultimately failed attempt, Obamacare poses the same sort of threat.
Even Americans who say they dislike the law actually like many of its
components. Nearly three-quarters approve of giving financial help to
poor and moderate-income Americans to buy health insurance.
Two-thirds
approve of barring insurance companies from denying coverage because of
somebody’s medical history. Three-quarters favor letting children stay
on their parents’ insurance until they are 26.
Until now, social welfare programs in the United States have exhibited a
“big hole,” Professor Skocpol said, consisting of nonpoor working-age
Americans and their children. Obamacare closes a big chunk of it.
“The main beneficiaries tend to have lower wages, employed in smaller
businesses that are not providing health insurance,” she said. “They are
not elderly. They are also not the poorest.”
And they might be grateful to Democrats for the benefit.
To conservative Republicans, losing a large slice of the middle class to
the ranks of the Democratic Party could justify extreme measures.
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