Republicans apparently will kill Obamacare mostly for show, then put much of it back incrementally over time with what will more closely resemble Hillary Clinton's proposed "fix" than Donald Trump's bellowed "repeal."
It's beginning to sound like Republicans object wholly only to two elements of the Affordable Care Act, and that those alone are certain goners.
One is the very idea of government telling people and businesses that they must purchase or provide health insurance. Republicans seem happy instead with merely encouraging that behavior, probably with some kind of tax credit.
It's a classic partisan and philosophical divide: Democrats like to tell people to do something for their own good and give them direct subsidies; Republicans say, oh, no, we're not going to tell you to do anything, because you are free, and we're not going to transfer anybody's wealth to you through government spending, because that is, you know, kind of socialism, which is evil. But, they hasten to add, we love cutting taxes and we'd be delighted to trim a little off yours if you'd do something for your own good and ours and buy health insurance.
There already is a tax write-off for health-insurance costs. This would be something a little extra for low-income people ... presumably, which is a word much in play in the current debate.
The other objectionable element for Republicans is that the cost of all this to the government--to taxpayers--is great and rising. Republicans want to put a lid on the taxpayer liability, ideally by finding efficiencies rather than letting sick people die in the street and hospitals go broke.
Thus we'd be left after a couple of transitional years with continued Medicaid expansion in participating states, probably in a block grant requiring states to run it by their own restrictions; still-existing health-care exchanges offering individual plans as now, but that no one would be required to buy, though people could get a credit on their income taxes for doing so; coverage of pre-existing conditions, perhaps with special at-risk pools; continued coverage for persons on parents' plans up to age 26, and probably some kind of corporate bailout, because Republicans don't mind those, so that insurance carriers could sell Escalades at 4Runner prices.
We would read big headlines imminently about Republican repeal of Barack Obama's supposed folly. Right-wingers could celebrate. But ballyhooed repeal would then give way over a couple of years to a low-key fix, or intended fix, that would mandate nothing and put a cap on government's costs.
This preposterous minority presidency might not be all that disastrous if it emphasized hollow headlines as a feint while it quietly went about imposing Democrat-lite policies.
All of that was put in greater focus Wednesday.
Washington was astir in bold talk of Obamacare's imminent demise by Republican hatchets. Meantime, in Little Rock, Gov. Asa Hutchinson and state Sen. Jim Hendren--our leading local Republicans--were telling the Capitol-covering media that the state is pretty much committed to continued Medicaid expansion.
Hutchinson was adding that the state conceivably could save money by cutting back the Medicaid expansion population and moving some of those people into the health-care exchanges where they'd get federal government help.
But Medicaid expansion is Obama-care. And those health-care exchanges with government help? They're Obamacare, too.
I asked Hutchinson about that. Here was his explanation: He said he was mainly talking about the transition period. But he said Medicaid expansion should continue beyond that, though only on the basis that states could do it their own fiscally efficient way, such as by making recipients use employer plans where available, pay higher out-of-pocket costs and seek work or work training. If states get in danger of overspending their block grants, then they should be able to trim back the Medicaid expansion population, maybe from 138 percent of the poverty level to 100 percent, and invite those in the gap--but not command them--to go into the exchanges, though not for government-subsidized premiums, but for premiums they would pay themselves in full and maybe get a tax credit on later.
That's a heap-load of tinkered Obamacare right there.
It amounts to transferring state expenses to the federal treasury and transferring taxpayer costs to low-income people.
It's standard Republicanism, in other words.
But it's not repealing Obamacare. It's declaring its repeal and then restoring a significant and adapted increment. It's fixing Obamacare, or trying to fix it.
It's not the worst thing in the world. Only if the Republicans did what the headlines say they're doing would we confront the worst thing in the world, or its vicinity.
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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers' Hall of Fame in 2014. Email him at [email protected]. Read his @johnbrummett Twitter feed.
Editorial on 01/08/2017