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The Left Saved the ACA



To amplify Erik’s recent point, this is exactly right. Sometimes, popular mobilization works:

The fallout from the collapse of Trumpcare has left most of the blame, or credit, on the House Freedom Caucus. President Trump has pointed his finger at the restive right-wingers, and news coverage has taken their central role (“the ultraconservative GOP lawmakers who stymied Trump on health care ”) as a given. It is true that the House Freedom Caucus made life difficult for Paul Ryan and the Trump administration. But it overlooks the main cause of Trumpcare’s failure, which is the revolt it generated from the left.

The left, not the right, was the source of public pressure, like large-scale rallies, inundating Congress with phone calls, and swarming town hall meetings. It was also the source of the opposition from doctors and hospitals, which stood to lose billions of dollars in business from customers who could no longer afford to pay for regular medical care.


Perhaps the most fatal barrier faced by the bill was the opposition of the Senate. Trumpcare was dead on arrival in the upper chamber, in part due to the opposition of a handful of arch-conservatives, but mostly because upwards of a dozen Republicans deemed its coverage inadequate. Some vulnerable House Republicans might have risked their seat to pass a bill slashing coverage to finance upper-bracket tax cuts. None of them were going to do it just to see their handiwork die in the Senate.

The most telling statement about the bill’s defeat came from Senator Bill Cassidy, a Louisiana Republican and an unexpected source of opposition. “There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care,” Cassidy told the New York Times.

The last point is also crucial, and is an illustration of why claims that either the ACA specifically or the Obama administration in general constituted a neoliberal repudiation of the New Deal/Great Society tradition is so deeply misguided. The ACA could not be more squarely within this tradition, in both its achievements and its compromises. The original Social Security was if anything even further from a model of what a public pension should look like (say what you will about the ACA, but racial ,minorities disproportionately benefited from it rather than being disproportionately excluded.) But a flawed compromise establishes a baseline public expectation that both entrenches the program against opposition and provides the basis for expansion.

The ACA could one day serve as the basis for European-style comprehensive health care (I think it is far more likely to follow the hybrid models than the single-payer ones, but which endpoint is more likely isn’t terribly important right now.) In the meantime, the public insurance programs can be expanded and the subsidies for private insurance made more generous. But to move down the path you have to get started. And both sides of the Democratic coalition in 2010 deserve credit for getting it done.

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