Say the word ObamaCare to most Republicans and all they really hear is the initial five letters, i.e. our ex-President’s name.
In the minds of these Republicans – such as they are – ObamaCare is a stand-in for President Obama himself. Their visceral, and sometimes racial, animus to Obama was entirely transferred to this legislation. It was his signature achievement and came to represent everything about him. You can’t separate the two. Repealing ObamaCare came to be thought of as handing an ultimate defeat to their despised foe. This is true even with the fig leaf of replacing it with “something better”, but with scant thought about what that might be, as events have amply demonstrated.
But with Obama comfortably retired to a life of leisure, and facing the realities of a health care system incessantly described as “one-sixth of our entire economy”, the Republicans flinched. The uncomfortable fact, still not yet acknowledged by Republicans, is that ObamaCare resembles democracy in being “the worst institution, but better than any other that we can devise and enact.” Oh yes, the socialist nirvana of a wholly government program like Bernie Sanders’ Medicare for All is alluring to progressives, but don’t hold your breath. We are not yet Sweden and in my opinion never will be, thank God.
Too many people now depend upon some of ObamaCare’s popular provisions to even contemplate risking their loss. It was the genius of the Obama administration to ensure that enough people were hooked on their nostrum to make it effectively comparable to Social Security as a third rail of politics. To this end they tied what was promoted as a public/private health insurance system for those not covered at work to a massive expansion of Medicaid. The original purpose of Medicaid was as a social health care program for some but not all individuals with limited resources. Just as FDR never intended Social Security to be a full backstop against income insecurity among the elderly, Medicaid had a targeted focus on those most in need. Now this was transmuted into a general welfare program extending well above the poverty level and with few meaningful restrictions. Once states accepted this lure, and most did, even many under Republican control, how could they possibly explain relinquishing this largess for an uncertain alternative?
Of course, it isn’t over yet. I expect that attention will now go toward the compromise being worked out by Sen. Lamar Alexander (R, TN) and Sen. Patty Murray (D, WA). If it emerges as a real piece of legislation, it won’t be able to carry the label “repeal of ObamaCare”, so will the Republican majorities in either House of Congress pass it? Frankly, I am skeptical. You might ask whether the President would then sign it, but I can make a confident prediction here. He will. And it really doesn’t matter much what its provisions entail. Trump is hardly an ideologue – that requires actually having some ideas – and he sorely needs a legislative victory. These have been few and far between so far and the future of the rest of his agenda seems bleak without this win under his belt.