President Barack Obama speaks about healthcare reform and the Affordable Care Act in Washington, Thursday, July 18, 2013. (AP Photo/Charles Dharapak)
Say someone blows the wheels off a moving train and blames the accident on whoever built the engine. Fair game?
That’s precisely what Republicans are up to with their onslaught against Obamacare. Their tactics go well beyond political opposition: as others have pointed out, what’s happening now is deliberate sabotage of a duly enacted and Supreme Court–affirmed law. This morning Norm Ornstein, a scholar at the American Enterprise Institute, called the GOP’s efforts to block the implementation of the law “unprecendented” and “sharply beneath any reasonable standards of elected officials with the fiduciary responsibility of governing.”
The GOP has a narrowing window in which to wreck the rollout and blame structural deficiencies in the law, and they’re intent on smashing their way through it. Not only are they sacrificing the well-being of millions of Americans—now they’re gambling the global economy, too.
Here’s a blueprint for the GOP’s sabotage act, which runs the gamut from spreading half-truths to, as John Boehner himself put it, “risk[ing] the full faith and credit of the United States.”
Refuse to expand Medicaid
The Supreme Court’s ruling last year gave states the right to opt out of the Medicaid expansion, which is one of the most significant pieces of the ACA in terms of the impact it will have on the uninsured and its importance to the overall success of the law. More than twenty states—most fully controlled by Republicans in the legislature and the governor’s office—are denying some of the neediest Americans care by refusing to expand the program. Some 9.7 million of the 15 million potentially eligible adults live in states that are refusing to expand or have not indicated whether they will do so.
Refuse to create state insurance exchanges
More than half the states have declined to establish their own insurance marketplaces. All but six are run by Republican governors and a Republican-majority legislature. Residents will still be able to buy insurance through the federal exchange, but without cooperation and promotion from state officials, it will be more difficult to reach the uninsured.
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Waste time and money voting for repeal
In the past three years, House Republicans have devoted at least 15 percent of their time on the House floor trying to ruin the ACA, voting thirty-nine times to repeal, defund or delay the law. These legislative efforts have cost taxpayers upward of $50 million. Meanwhile, the GOP hasn’t offered any alternative healthcare plans of its own. These votes present no existential threat to the law, since repeal will never get through the Senate or the White House. But repeated attacks reinforce the idea that the ACA is still up for debate and that its future is uncertain. As of April, four in ten Americans were unaware that the ACA is the law and that it is being implemented.
Block improvements to the law
While implementation has brought certain weaknesses in the ACA to light, there’s about zero chance that the GOP will support operational or funding fixes. Some of the concerns raised—for example, that employers will cut full-time workers in order to avoid providing insurance for their employees—could be met with simple changes. If the GOP’s full-out attack on the Obama administration after its decision to delay the employer mandate for a year in order to smooth out some of these issues is any indication, the GOP will do no more than exploit efforts to improve the law.
Publicize misinformation
Republicans squawking about rate shocks are presenting misleading numbers, particularly in Indiana and Ohio. One of the simplest ways the GOP fudges calculations to make anticipated premium prices look higher than they will be is by not factoring in the federal subsidies that will cut the cost of the premiums for most people buying coverage. Expect the volume of lying to rise when legislators return to their home districts during the August recess.
Discourage private partnerships
When Massachusetts was promoting Romneycare in 2007, the state partnered with the Red Sox to educate residents about the new law and encourage enrollment. Public education is key to the ACA rollout, too, and the White House has enlisted celebrities and sports franchises to raise awareness, particularly in target groups like healthy young men. The GOP is trying to scare off potential partners, and it has already succeeded with the NFL.
Refuse to assist constituents
Not only are Republicans spreading misinformation and ruining education campaigns, they have also indicated that they won’t help confused constituents navigate the law or access benefits. Congressional offices expect a wave of calls once enrollment begins in the fall, but several Republicans told The Hill they weren’t preparing to answer questions. “All we can do is pass them back to the Obama administration,” Utah Representative Jason Chaffetz said. “They’re responsible for it.”
Hold the entire government hostage
The fiscal year ends in twenty-three days, and Congress and the White House aren’t anywhere close to a budget agreement. More than a dozen senators, including the number-two and -three Republican leaders John Cornyn and John Thune along with Marco Rubio and Rand Paul, sent a letter to Harry Reid this week threatening to shut down the government if any money goes to implementing the ACA. “If Democrats will not agree with Republicans that Obamacare must be repealed, perhaps they can at least agree with the president that the law cannot be implemented as written,” the letter reads. “We will not support any continuing resolution or appropriations legislation that funds further implementation or enforcement of Obamacare.”
Minority leader Mitch McConnell, who did not sign the letter, told reporters he planned to abide by a budget agreement worked out in 2011 that contains funding for the ACA. John Boehner warned back in March that wagering “the full faith and credit of the United States over defunding Obamacare” would be “a very tough argument to make.” Still, shutdown threats could cause a major headache, and they may resurface in the debt ceiling negotiations that will follow an eventual budget deal.
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Why work to undermine the Affordable Care Act so aggressively if, as Republicans claim, the law is fundamentally flawed? One reason is that the party hopes to leverage the chaos into political benefit. More significantly, the risks of an effective ACA are just too high. Once the full range of benefits begins to reach people with pre-existing conditions, low-income adults, employees and millions of other citizens, it’s going to be a lot harder to make the argument that the ACA is ruining the country or that such benefits should be denied.
Even conservatives like pundit Byron York are looking in trepidation to January 1, when federal dollars to offset premiums will begin to flow. “At that point, the Republican mantra of total repeal will become obsolete,” York wrote earlier this week. Ultimately, success would prove just how much time and money the party has wasted in making opposition to healthcare their chief policy platform.
The House narrowly defeated a bill that targeted the NSA’s surveillance, but the results of the final vote were still remarkable.
