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How To Respond to the War on the ACA

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As you know, one of Paul Ryan’s central goals is to take away the health insurance of tens of millions of people to help fund massive upper-class tax cuts. How should Democrats respond? I think this is essentially right. In summary:

  • As with all other issues, the default position of the Democratic caucus should be “no.” Make it clear that there will be no initial negotiations on a replacement plan.  Hope that the tensions within the Republican caucus either cause the effort to collapse on itself, or results in repeal-and-replace. The longer this drags out, the better the chances of preserving the ACA. Obstruct. Delay. Vote no.
  • If the Republicans were to offer cosmetic changes to the ACA — slightly less generous subsidies and more rentier skimming for Medicaid, say, but preserving the basic structure of the ACA and making it worse in ways that could be fairly easily fixed by the next Democratic Congress — this would be one of the few instances in which the bad politics of collaborating with Republicans would be substantively beneficial enough to be worth it. But I think this will be a moot point. This would be the smart political play for Republicans, and I suspect McConnell would go along — but I don’t think Ryan will.
  • If the Republicans are actually determined to pass a horrible statute that will effectively deny tens of millions of people access to health care through a combination of locking people out of the market because they can’t afford or qualify for insurance and allowing companies to sell completely worthless insurance, then the default position holds — no Democratic votes, no negotiation to season the shit sandwich, the end. If Republicans are going to do this, make sure they own it. And, as Chait says, since the only way the Republicans can take away the health insurance of tens of millions of people to help fund massive upper-class tax cuts in this scenario is by nuking the filibuster, this would produce institutional changes that would be very beneficial for liberals in the long run — not least in healthcare policy. And making Republicans own this catastrophe makes it likely that the next Democratic Congress happens sooner rather than later.

Can #3 — certainly the worst of these scenarios — be averted? I don’t know. But while I don’t think Trump is preferable to a generic Republican overall, this is one issue where having Trump rather than Cruz or Rubio or Pence is actually useful.  It’s hard enough to pass healthcare reform when a popular president has a clear agenda and is very focused in getting Congress to pass it. The Republicans are being nominally led by a massively unpopular buffoon who has no idea what he’s talking about and a personality that requires constantly humiliating negotiating partners and reneging on commitments making promises about health care reform that completely undercut the “equal access” bullshit Ryan is trying to sell his marks on. Does this make it impossible for Republicans to kill the ACA? As much as I wish that green lanternites and their president-centric view of the legislative process were right, it doesn’t.  But it does make a heavy lift heavier, and Democrats need to leverage Trump’s unpopularity and politically unhelpful statements while maintaining a laser focus on making Trump as unpopular as possible. A lot of lives are at stake.

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