President Barack Obama is about to save Congressional Republicans from themselves.
Wednesday afternoon, the House of Representatives passed a bill to repeal Obamacare and strip taxpayer funds from Planned Parenthood. The legislation passed 240-181 almost entirely along party lines, while the Senate version passed last month through a process called budget reconciliation, during which filibusters are not allowed.
Democrats used this same process to amend the Affordable Care Act in 2010 after losing their sixtieth Senate seat to Scott Brown of Massachusetts in a special election.
After more than 60 votes, Congressional Republicans have finally achieved their long-stated goal of passing a bill to repeal the Affordable Care Act. It’s legal, if technical, and not passed through any means that Democrats haven’t used before.
Unsurprisingly, Obama has vowed that he will veto the bill.
This is a political power move by the GOP caucus. With primaries now the determinant for most seats in the House and Senate (intra-party challenges being far more likely to unseat an incumbent than between parties), many conservatives will take the next few months to shore up their flanks against a challenge from the Right headed toward November, 2016. This is especially true for Speaker Paul Ryan, who has come under fire from many Conservative groups for cooperating with Democrats on this fall’s budget.
Having seen what happened to Virgian's Eric Cantor even the leadership knows it’s vulnerable, so Ryan has made clear that his “first priority in 2016 [is p]utting a bill on Obama’s desk that repeals Obamacare.”
Yet nothing will give Senate Republicans the votes they need to force an override, meaning that their bill will get no further than the Resolute Desk. This is a symbolic gesture on the part of the caucus going into a fraught election year. As Ryan said during a press conference following the passage, the caucus’s “top priority in 2016 is going to be offering the country a clear choice with a bold pro-growth agenda.”
This bill is about setting the table for elections to come, but Obama’s promised veto is the only reason Republicans could pass it in the first place.
One of the dirty little secrets of the “repeal and replace” movement has been how entirely it depends on Democratic control of the White House for its form and function. After five years of vowing to come up with an alternative to Obamacare, Congressional Republicans still have nothing more than the occasional Powerpoint presentation to show for their efforts. No actual legislation has been drafted, which is why the House has held 60-plus votes to repeal the law and zero to institute a replacement.
This isn’t because the GOP’s leadership is dishonest or lazy or stupid. It’s because it’s impossible to square the circle that they’ve promised voters.
The Republican Party boxed itself into a no-win situation years ago when it conceded the central premise of health care reform, a need to increase access to insurance and end the practice of pre-existing conditions. At the same time they’ve promised voters that this can be achieved without either a) an individual mandate or b) government subsidies/single payer.
No one has yet figured out a way to deliver on all of this at once. Stripping the individual mandate would transform risk pools into death spirals. Stripping government subsidies would make health insurance unaffordable for many, likely invalidating the individual mandate (it being unconstitutional to enforce a law that people cannot reasonably obey) and leading, again, to death spirals.
Meanwhile, heavy subsidies or single payer is anathema to Conservative ideology.
So in practice there’s no replace and likely to be none. But politically there can be no repeal without it. Millions of Americans have health insurance now that they wouldn’t have otherwise. While many people have complained about premium hikes rates have gone up a mild 7.5 percent nationwide. Perhaps more importantly, markets with double digit hikes are ones where insurance companies undervalued their rates during the early years of Obamacare markets. What major increases exist are in areas where abnormally low premiums are correcting towards normal.
The point isn’t to make a defense of Obamacare but rather to suggest that the average American’s kitchen table experience with the law isn’t that bad, or even really noticeable.
And that’s very important because if Congressional Republicans did manage to repeal Obamacare they’d create a political two-step. First it would fire up the base, guaranteeing sweeping victories for most incumbents in the primaries.
Then, in November, gleeful Democrats would air round the clock ads showing the “victims of Conservative ideology.” Stories of the formerly insured (now a large, angry voting base) would waft across Americans’ television sets, and even in this age of rigid party alignment the message would get across to at least a few: your life hasn’t changed, but theirs has.
As Conservatives knew at the time, their last chance to uproot Obamacare was before it took effect. In 2012 this was a war over 2,400 pieces of paper. Now it’s a movement that, if successful, would associate the Republican brand with stripping insurance from nearly 20 million people and reintroducing pre-existing conditions.
Outside the party faithful that would be about as popular as… well, a pre-existing condition.
The same can be said for defunding Planned Parenthood.
Congressional Conservatives have vowed to strip taxpayer money from the group ever since a series of videos went viral last summer purporting to show administrators and doctors casually pricing out fetal tissue. The videos were heavily and deceptively edited, but the damage was done.
Movement Conservatives seized upon it as an opportunity to pursue their campaign against Planned Parenthood, long a target for its affiliation with abortions.
However abortions constitute only 3% of Planned Parenthood services. According to CBO estimates roughly 2.6 million women depend on the organization, and overwhelmingly for cancer screenings, pap smears, STD tests and treatments and birth control.
And, yes, some depend on it to terminate unwanted pregnancies.
Shutting down their local clinic would throw most of those women onto social services such as Medicaid and welfare, the ones who can find any resources at all. Most would simply have to go without the kind of essential preventative care that Planned Parenthood provides. Altogether, between social and emergency services, the CBO estimates that cutting off funds would cost the government $620 million (compared to the $500 million per year that it would save).
All targeted at women.
That might be enough to put Hillary Clinton into the White House.
During an election year in which gender will almost certainly play an enormous role, the Republican party knows that it cannot afford to lose the voting block known as “women,” a constituency that has somehow has managed to creep up on the party elders while they were busy courting the votes of NASCAR Dads. Nevertheless it's a sizable voting block, making up a shocking 50.4% of the entire population (not counting for children and felons).
Like the ready-made ads about health insurance, Democrats would pounce virtually instantly on Republicans and the “War on Women” would not only gain traction but would stick around straight through the 2016 election. It’s a fight that conservative lawmakers can only lose, damned by the general public if they do and damned by their primary base if they don’t.
Fortunately, for now, they have a third option. They can’t.
Like their 60 previous votes, held in the sure knowledge of a filibuster, a presidential veto allows Conservatives to pass this bill confident in the knowledge that they can both get credit for trying and avoid the consequences of success.
That’s not to downplay what Wednesday’s vote means. These are legitimately held right wing policy positions after all, even if ones unpalatable to a presidential cycle. Yet the chaos they would unleash cannot be overstated. Simply ripping out a law as complicated as the Affordable Care Act would not only cost many people their insurance, while rewarding a small but meaningful number with lower premiums; it would also send shockwaves through an entire industry that has spent five years rewriting its business practices around this law.
Ryan has promised a bill to replace the Affordable Care Act by the end of 2016. The bill to repeal it will be delivered to Obama’s desk on Thursday, where it will receive a very loud veto.