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They’re Going to Keep Coming For Medicaid

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WASHINGTON, DC – JANUARY 07: Speaker of the House Paul Ryan (R-WI) (3rd L) shares a laugh with Republican members of Congress after signing legislation to repeal the Affordable Care Act, also known as Obamacare, and to cut off federal funding of Planned Parenthood during an enrollment ceremony in the Rayburn Room at the U.S. Capitol January 7, 2016 in Washington, DC. President Barack Obama has promised to veto the bill. (Photo by Chip Somodevilla/Getty Images) *** BESTPIX ***

One reason the midterm elections are so important is that they represent the only chance to seriously investigate the Trump administration before 2021. Another reason is that the narrowly failed attempt to gut the ACA will almost certainly be revived:

Many Republicans assume their party will take another stab at repealing and replacing the Affordable Care Act if the midterm elections go their way, even though GOP candidates aren’t making a big deal about it on the campaign trail.

What they’re saying: “Repeal is like fight club,” one GOP operative told me. “First rule is not to talk about it.”

There’s a decent chance Republicans won’t be in a position to try again, in part because their last effort was so unpopular. Health care is front and center in Democrats’ bid for the House majority, and recent polling shows that Democrats have an edge on the issue.

  • That’s also part of the reason Republican candidates aren’t campaigning on ACA repeal as aggressively as they have in the past.

But if Republicans hang onto the House and expand their majority in the Senate, lawmakers and aides generally assume another repeal vote would happen.

This is particularly instructive:

There are two big obstacles: Losing too many House seats to pass a repeal bill there, and finding a replacement plan that could get more votes than the last effort.

  • For now, the block grant proposal that Sens. Bill Cassidy and Lindsey Graham put forward last year remains the leading policy option.

  • “Don’t make it a cutting Medicaid exercise — make it a ‘screw the blue states’ exercise and block grant to states with normal Medicaid growth, and you win,” a senior GOP aide said.

As with the vast majority of the neoconfederate doctrines of the Rehnquist and Roberts Courts, the re-writing of the Medicaid expansion is not worthy of any respect, not least because the bad faith is utterly transparent. If Republicans actually valued state sovereignty and experimentation, the status quo on Medicaid would be fine to them. But of course they don’t actually value these things; the operative principle is “nobody should have nice things.” If that means limiting federal power, fine, if this means imposing federal power on the states fine, but that’s the only end.

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