House Republicans may or may not begin the repeal and replacement of the Affordable Care Act, and ironically, their most conservative faction may turn out to be the rescuer of what GOP politicians refer to only as “Obamacare.”
The irony comes in the fact that though House Speaker Paul Ryan’s “replacement” curbs the number of people with subsidized premiums, moves back to the “free market” approach, cuts taxes on the wealthy and medical device manufacturers and might toss millions of people off Medicaid, conservatives still don’t like it. They attack the tax credits offered as a weak substitute for subsidies that helped lower-income people pay for ACA-connected coverage. Why? Because they think there should be no tax credits.
So there may be enough of those tea-party Republicans to stop the replacement.
And from 4th District Rep. David Price comes some hard truth: He announced Wednesday that the GOP plan would cost North Carolina residents an average of $7,500 more a year in health care expenses.
President Trump made the so-called “disaster” of Obamacare central to his campaign, focused not on specifics but on President Obama as a target of the extreme right wing. The Affordable Care Act brought more than 20 million people into the insurance system, and it worked. The deficit didn’t blow up; the private insurance system didn’t collapse. But Republicans have continued to attack the ACA in a clear effort not to help people get health insurance, but to erase a powerful legacy of a Democrat they despised.
And, then there are those cuts to taxes that fund the ACA. Republicans want to give a big gift to their wealthy backers. That’s the real promise they want to keep, not the promise to repeal and replace “Obamacare,” because they know public support for that is shaky at best. Just as there are signs in polling that President Trump’s approval ratings are diving, so there are signs that the ACA is not nearly as unpopular as Republicans want to believe it is. In addition, the Congressional Budget Office found that while repeal of the ACA would cut the deficit, it also would put millions of people on the rolls of the uninsured and cause insurance premiums to rise.
Mark Meadows, the congressman from North Carolina’s 11th District who is a champion of the hard right, is one of those most vehement about repealing the ACA without worrying about protecting health care insurance for the poor. Trump even singled Meadows out in a meeting, twisting his arm to get him to support Ryan’s version of repeal and replacement.
Republicans led by Ryan are determined to push ahead with something for which public support has faded in the shadows of the presidential campaign. And if in the process they dump millions of Medicaid recipients off the rolls of the insured (reversing the expansion adopted by many states under the ACA) and make it impossible for millions of others to afford insurance, their hard-line ideology may backfire.