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MARTY WISEMAN – Republican candidates and the Affordable Care Act: the plot thickens

MARTY WISEMAN

MARTY WISEMAN

With each passing day, the anticipation of the first debate among the 15 or 16 Republican presidential candidates grows more intense.  Under the Fox format only the top 10 will make onto the stage.  Where would we political junkies be without Donald Trump?  When the GOP hopefuls stormed out of the blocks one could fairly easily guess what the major issues would be and assume that the debates would entail arguments over who could express the most intensity with regard to topics that they all basically agreed upon.  Regardless of the outcome of recent Supreme Court cases the certainty of a discussion of the Affordable Care Act (Obamacare to the Republicans) was a foregone conclusion. My have the waters ever been muddied!  Lo and behold, right in the middle of the process of turning the disdain for any Obama approach to national health insurance on its head comes Mr. Trump himself proclaiming his absolute support for national universal health coverage.  That would normally be no big deal coming from an outsider such as Trump but this time “The Donald” will join the debates as the leader in the polls for the Republican nomination.

The GOP’s candidates facing a dilemma.  That is, whether to continue their all out, assault on the Affordable Care Act or concede that, at least until January of 2017, “Obamacare” is the law of the land and, in fact, it is gaining permanence by the day.
The Supreme Court holding in King v. Burwell would seem to be tantamount to setting the national health plan in stone.  Indeed there is growing political risk associated with snatching health plans in their entirety from increasing millions who are coming to depend on them.  Furthermore, the numbers of those who are gaining intricate knowledge of this Rube Goldberg like Affordable Care Act realize that all who have health insurance from any plan benefit from several features such as mandatory coverage of pre-existing conditions, free annual tests such as mammograms, coverage for children up to age 26 and several other similar items that appeal to the average American.

So, after more than 50 votes to totally repeal the Affordable Care Act by the Republican dominated U. S. House of Representatives, what will be the GOP path from here?  No doubt, there will be some who vow to continue their efforts at total repeal until their last breath.  Perhaps the more practical route will be embraced by those who fear the magnitude of the backlash generated by the “total repeal” crowd.  Their approach would entail making Republican favored adjustments to the current act.  No doubt such actions could be and would be prefaced by numerous statements claiming incompetence by the father of “Obamacare.”  But the reality, in the event that this action is chosen, is that Republican policy makers would be, for all practical purposes, accepting and indeed improving the once loathsome Affordable Care Act.  Thus the GOP would be contributing to the potentially improved workability and the permanence of a form of national health care.  Probably the bitterest aftertaste of taking such a pro-active approach to “fixing” the Affordable Care Act is that then the Republicans would have a vested interest in the success of “Obamacare” lest their policy making effectiveness be called into question.

The GOP’s herd of candidates are facing a dilemma.  That is whether to continue their all out assault on the Affordable Care Act or concede that, at least until January of 2017, “Obamacare” is the law of the land and, in fact it is gaining permanence by the day.

A third option would be to simply do nothing and allow the Affordable Care Act to languish or succeed on its own.  The political risk here is in “Obamacare” succeeding and President Obama and the Democrats being accorded total credit for fighting alone through the impediments placed in their way by a hide-bound opposition party.

Of late, the Republican approach has been one of citing what they claim is an Affordable Care Act induced dramatic premium increases, onerous deductibles and co-payments as evidence that the insurance industry is hard pressed to support what Republicans would label as an ill-conceived approach to universal health care.

Given the array of choices, what is the bottom line?  With the first debate looming the Republicans have no good choices.  In the case of complete repeal of the Affordable Care Act the political price might well be unacceptable.  In the event of an effort by Republicans to repair and strengthen “Obamacare” they find themselves in a role of repairing something that they had made the case was absolutely unworkable.  Certainly this would be viewed by many as waving the white flag of surrender.  Doing nothing and instead choosing to highlight the inability of insurance companies to perform the role intended for them would at best allow President Obama to claim this as a major part of his legacy but at worst may carry the potential for the most objectionable of all risks for the GOP — a default to a universal single payer system in the face of rising support for government involvement in guaranteeing access to health care.  Alas, Republicans had best come to grips with the fact that the opportunity to beat President Obama over “Obamacare” has disappeared.  And who best to do that but the current leader for the GOP presidential nomination and advocate for universal health care for all Americans — Donald Trump? Aug. 6 could not arrive soon enough!

Dr. William Martin Wiseman is director of the John C. Stennis Institute of Government and professor of political science at Mississippi State University. Contact him at marty@sig.msstate.edu.

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