Rename and Repair “Affordable Care”


The struggle over the future of the Affordable Care Act (ACA), popularly known as Obamacare, ended a crucial round last month, when, in the Senate, three Republicans–Susan Collins, John McCain, and Lisa Murkowski–joined Democrats in voting down the so-called “skinny repeal.”  Despite Republican majorities in both houses of Congress, and despite the president’s scornful goading, the GOP has at long last stopped in its tracks: it has heard, from far off in the hinterland, the howl of the people.  To repeal the Affordable Care Act, to discontinue its hallmark features, has become politically unacceptable in the US.

Partisan representations of the bill notwithstanding, the guarantee of affordable medical coverage for all, which is at the heart of “Obamacare,” has become a grail to the American people.  Kate Zernike and Abby Goodnough of the New York Times co-authored a fascinating article describing how a sea-change in popular sentiment, running increasingly in support of the ACA, has occurred along with its threatened repeal.  First-hand understanding of the bill’s provisions and benefits are driving Americans to an acceptance of universal coverage that makes the GOP’s top-down rhetoric a tougher sell.  Americans do not want to return to the “bad old days” when insurers could turn sick or at-risk customers away.  They do not want millions of Americans who are now insured to lose the benefits guaranteed them under the ACA.

Politically, then, the President and the GOP face the issue of how to Affordable Care their own.  (After all, it has the makings of a smashing success!)  During the presidential campaign, then-candidate Trump wasn’t at the forefront of those calling for the ACA’s repeal.  He was the reasonable candidate then, wanting to find solutions that would remedy the defects of the legislation.  During the debates, he suggested eliminating state-level restrictions to allow insurers to create pools across state lines.  Ironically, President Trump has since decided that scapegoating others is essential to his popularity, a conviction that has led him away from an approach to health care that was more constructive and reasoned.  Has the President never heard the saying, “Revenge is a dish that is best served cold”?

Were I a Republican, I would vow never to utter the word “Obamacare” again.  Members of the Republican Party stand to become heroes by repairing the Affordable Care Act and re-branding it to heighten its associations with compassion and inclusion.  Forget about wreaking revenge on Obama.  Listen to the people.  Collaborate with Democrats.  Deliver a shared triumph to the nation.  It will matter far more than any partisan loss.

Image: from this source.
“The National Dime Museum” by Bernhard Gillam
is a send-up of leading American politicians circa 1884.

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The Trump Years: Day 56

Ordinary Americans will soon learn how they are to figure in the grand story of the future the GOP is always telling.  It’s a story that sees America and Americans as trammeled by rules that bug them and taxes so onerous they can’t sleep at night, that sees happiness as a precipitate left over after “school choice” causes public schools to evaporate.  The Republican narrative promises to rescue Americans from a tyrannical government and recent policy “disasters.”  Long-term security will grow rather than decrease once the nation is liberated from the Affordable Care Act (“Obamacare”) and the tangible health benefits it guarantees.

This rhetoric is about to collide with physical reality.  Will a Republican-led Congress be so vain and rash as to abandon health guarantees that an entire nation has grown accustomed to?  Yes, Congress should act to constrain premium increases and restore competitive insurance options where they are lacking, but why deprive the nation of the happy consciousness that we’re all in it together, which is, at bottom, the signal benefit of Obamacare?  This is precisely what Republicans are most eager to destroy.

Under the present system, some well-off Americans are obliged to spend more for insurance than they would like; however, millions of Americans are newly insured, and hundreds of thousands are addressing health problems that have afflicted them for years.  Knowing that we are achieving something so gloriously humane makes the hassle and collective sacrifice worthwhile.  If Congress were wise, it would aim at enhancing this precious peace of mind.

Image: 80,000 miners listening to Theodore Roosevelt
(1905 daguerreotype by Underwood & Underwood),

from this source.

The GOP obstructionists

Who are the obstructionists intent on defunding Obamacare and delaying its implementation?

I appended to Monday’s post on Republican Fire-Eaters this list, compiled by fellow blogger Eric Prileson, giving the names and phone numbers of the 228 Republicans and 2 Democrats who passed a House spending bill to this effect on September 20.

The determination of the House to “hold up” the government until the Affordable Care Act is modified to its liking solidified when House Speaker Boehner and other G.O.P. moderates decided, once again, to cave in to the far-right members of their party.  The 80 radical Republicans leading the charge have been nicknamed the “suicide caucus”–an apt coinage highlighting their resemblance to a terrorist group.

As Thomas L Friedman and others have noted, this group is a minority with some striking geographical and sociological peculiarities.  I encourage you to read Ryan Lizza’s geographical analysis of the suicide caucus, recently published on the New Yorker website.  Accompanying it is a dandy map, based on data from The Cook Political Report, showing the “upcountry” character of the caucus’s constituency. Click on the map to go to its source.

congressdistricts_final-01.png

Lizza:

The geography of the suicide caucus shows . . . [that] half of these districts are concentrated in the South, and a quarter of them are in the Midwest, while there’s a smattering of thirteen in the rural West and four in rural Pennsylvania (outside the population centers of Philadelphia and Pittsburgh) . . . . there are no members from New England, the megalopolis corridor from Washington to Boston, or [from] along the Pacific coastline.

These eighty members represent just eighteen per cent of the House and just a third of the two hundred and thirty-three House Republicans. They were elected with fourteen and a half million of the hundred and eighteen million votes cast in House elections last November, or twelve per cent of the total.

The districts represented are also whiter than the nation as a whole.

The South, where many of the obstructionists live, is home to some of the nation’s unhealthiest populations.  Most Southern states, under Republican control, have decided against implementing the ACA-funded expansion of Medicare that might have benefited their neediest citizens.  This interactive map, published in today’s New York Times, shows the millions of people who will be affected by their choice.

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Minorities, if sufficiently intransigent, can cause great harm if the majority fails to neutralize or contain them, leading to a frightful dynamic that President Lincoln, long ago, most eloquently described.

The Next Political Football: Medicaid

Last week’s Supreme Court ruling on the Affordable Care Act has placed a spotlight on the expansion of Medicaid benefits that the legislation envisioned.  Reactions to the Court’s ruling, which gave states the right to opt out of the expansion, again illustrate the state-level differences in our political culture.  Already a number of states, notably Florida, have declared their states will not be going along, while others (including California, New York, and Illinois) have embraced the measure.

THIS INTERACTIVE MAP on the PBS News Hour website allows you to see where each state stands with respect to the plan and the number of eligible recipients who will be affected in each.

Readers may also be interested in the maps below, showing the US House and Senate votes that led to the passage of the health reform bill.  Click on the maps to see larger maps and full legends.

https://i1.wp.com/upload.wikimedia.org/wikipedia/commons/thumb/5/54/111th_Congress_roll_call_165.svg/256px-111th_Congress_roll_call_165.svg.png

US House vote on March 21, 2010,
by congressional district, showing yeas and nays by party.

https://i0.wp.com/upload.wikimedia.org/wikipedia/commons/thumb/9/92/111th_Congress_1st_session_Senate_roll_call_396.svg/256px-111th_Congress_1st_session_Senate_roll_call_396.svg.png

US Senate vote on December 24, 2009, by state.

Maps courtesy of Kurykh on Wikimedia Commons.


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Susan Barsy, Progress Isn’t Popular, Our Polity.
Susan Barsy, A Decision We’ll All Feel, Our Polity.
Susan Barsy, The Map of Federal Benefits, Our Polity.
Susan Barsy, Help Understanding the Budget, Our Polity.

Progress Isn’t Popular

YESTERDAY WAS a great day for majorities.  A majority of the Supreme Court upheld the majority of the Affordable Care Act, a complex but very necessary piece of legislation that majorities in Congress had passed more than two years back.

Besides the great satisfaction that comes from watching the various branches of our government working in the intricate ways our forefathers envisioned, yesterday’s events furnish an opportunity to reflect on the great courage required of leaders in our contentious democracy.  I hope every congressman and senator who voted for the passage of the ACA will feel more comfortable taking credit for this landmark legislation.

I’m sure the Affordable Care Act is imperfect and that down the line it will need to be tweaked.  But the complex provisions of the law are complex for the very reason that they represent an accommodation: an accommodation of many powerful private interests, institutions and professions, as well as a dizzying range of individual, programmatic, and social needs.  The health-care reform act will affect us all, and it will shift around the burdens of health care in our society; but it marks a path toward a healthier society, so far the only one a majority of our legislators has managed to agree to.

A minority of Americans will continue to rail against our national institutions, and will try to convince the rest of us to hate a measure likely to confer broad benefits on us, both individually and as a society.  May their cries fall on deaf ears, and may they remember that the very foundation of our system is a respect for majority rule.

RELATED:
Susan Barsy, A Decision We’ll All Feel, Our Polity.
David Brooks, Modesty and Audacity, New York Times.