Republicans have a new idea on the path forward for the Affordable Care Act. Or, rather, in lieu of a new idea they have a new buzzword: repair.
It was suggested to them not by a health policy guru but by Frank Luntz, a prominent Republican consultant who specializes in buzzwords. Luntz, according to a team of Bloomberg reporters who asked him about it, recommended the term because it “captures exactly what the large majority of the American people want.” As he explains, “the public is particularly hostile about skyrocketing costs, and they demand immediate change.”
As Kelsey Snell and Mike DeBonis report, this new buzzword has in some ways merely added to the confusion in GOP ranks, with members interpreting repair as meaning anything from abandoning the goal of full repeal to merely being a synonym for it.
Nobody knows what “repair” means
To some repair proponents, including Lamar Alexander, the chair of the Senate health committee, it seems to mean moderating the pace of change. If a bridge is broken, he says, “you send in a rescue team and you go to work to repair it so that nobody else is hurt by it and you start to build a new bridge, and only when that new bridge is complete, people can drive safely across it, do you close the old bridge.” So repairing Obamacare means going slow with changes.
Paul Ryan doesn’t want to go slow — his passion in life is reducing government benefits for the poor as drastically as possible — but he’s convinced of the merits of the new buzzword. So in his view, “repair” means, as he told Fox & Friends on Thursday morning, that the GOP wants “to repair the US health care system.” And to do that, “you must repeal and replace Obamacare.”
Snell and DeBonis report that Orrin Hatch, who chairs the senate finance committee, professes to be agnostic between the two ideas. He said that he “could stand either option” and he’s “open to anything.” At the end of the day, he says, “anything that will improve the system, I’m for.”
The reality, however, is that whether Republicans call it repairing Obamacare or replacing it, they are going to be stuck with the exact same problem — Americans want better health insurance, but Republicans want them to have worse health insurance.
The fundamental GOP dilemma
As Luntz said, what Americans fundamentally want is for their health insurance to be both generous in terms of what it covers and affordable in terms of the premiums they have to pay for it. The Affordable Care Act tries to deliver that by subsidizing people’s insurance premiums. Those subsidies cost money, and that money was found largely through taxing rich people.
Republicans think that rich people are overtaxed in the United States. Indeed, a commitment to lower taxes on rich people is a core tenet of the modern-day Republican Party. Some think that reducing their tax burden will supercharge economic growth. Others think it is simply immoral that high-income households pay as much as they do. And others still think that both are true.
That means that whether they call it replacing Obamacare or repairing it or whatever else, all of their plans involve rolling back the tax increases on the rich. That leaves less money available to subsidize insurance for the nonrich. And that means the nonrich will either need to pay higher premiums or accept stingier coverage.
Beneath all the verbal dancing and legislative shadowboxing, there is a fundamental issue. While it’s true that there’s a lot about the Affordable Care Act that is disappointing and that Republicans have been able to leverage that disappointment in political gain, what voters want is better insurance coverage, and what the GOP wants is lower taxes and worse insurance coverage. No matter what you call it, eliminating or degrading millions of insurance plans to cut taxes for millionaires is a tough political sell.