From Donald Trump through Mitch McConnell and down to Asa Hutchinson and the right-wing Arkansas Legislature, the Republican position on the health insurance and health care of Americans has clarified.
It is a hollow plan in five cynical parts:
• Get a federal appeals court in New Orleans to throw out the Affordable Care Act so that it will appear that Republicans have gotten rid of a programmatic failure.
• Trust in an immediate stay of the ruling for an appeal by California and other blue states to the U.S. Supreme Court, pushing the matter past the next election and providing in the interim that the Affordable Care Act remains in place. That's because Republicans need its coverage of pre-existing conditions. It's because they have no remote idea how to reassemble Humpty Dumpty after they effect his great fall. It's because they want the rhetorical point for now but not the responsibility until later, if at all. It's the way Pennsylvania Republican Sen. Pat Toomey put it at a town hall in 2017: All that Republican talk of "repeal and replace" was mouthed in 2016 with reasonable confidence that Trump would lose.
• Hinge their own lack of immediate action on the fact that Nancy Pelosi and the Democrats now run the lower chamber of Congress and Republicans couldn't get anything passed even if they had a clue and even if they tried.
• Run for president and Congress on the court-driven headline of a supposedly failed program, buffered by the continued effectiveness of that very program on which they rely while asserting its failure, and promise that they will unveil a wholly unknown new plan, which they don't have, after they keep the presidency and take back all the Congress in November 2020.
• Warn voters during the 2020 campaign that, if they vote Democratic, then Bernie Sanders and Alexandria Ocasio-Cortez will set up a socialist system of health care, though Sanders and AOC advocate less than that, meaning continued private health care but with bills paid by a singular government source.
Trump will assure everyone that the Republicans will be offering "great" new insurance that will cover as much or more and cost less, as if that was possible in the business plan by which insurance--indeed, the capitalist marketplace--works.
Trump says "great" when he has no command of what he's talking about, which is why he says "great" a lot.
Whatever the Republicans might construct if in charge in 2021 would almost assuredly remove federal assurance of equitable coverage of pre-existing conditions and throw cancer victims to the crapshoot of state-by-state inequity.
Or they might go with the nonsense of Louisiana Republican Sen. Bill Cassidy, a doctor who plainly leaves business matters to others.
He says Republicans should simply guarantee equitable coverage and rates for pre-existing conditions and throw out the rest of the Affordable Care Act.
That's the Blue Cross bankruptcy plan. It's like telling the housing industry to build everyone a mansion and charge everyone $175,000.
You simply cannot equalize the cost and breadth of a service unless you provide subsidies for classes of customers in their varieties of circumstances.
In Arkansas, a relatively responsible Republican--name of Hutchinson, first name Asa--is forced inevitably to adapt to this nonsense.
He has struggled to save Medicaid expansion in the state even as his president and party are seeking to destroy it in a federal appeals court. But he seeks to reconcile all that by saying we need both to blow up Medicaid expansion and save it--blow it up by doing away with the program we have now, and save it in an equivalent fashion by replacing it with the same plan but with a work requirement for recipients.
Trump is saying blow it up now and hope the courts will stay the destruction while we promise to replace it with something we haven't thought of yet.
So Hutchinson is left to say, essentially, "Yeah, what Trump says."
He has again coaxed the Republican Legislature into re-upping the appropriation for Obamacare's vital and working Medicaid expansion because it would be chaos in the state's health-care infrastructure without it. He professes to prefer that--someday in the future--Republicans in Washington will deep-six this horrible Obamacare on which we desperately depend and put in something just peachy, if altogether unknown and unknowable.
Trump, Republicans in Congress and a local Republican like Hutchinson ... those are three entirely different kinds of political animals. But they are held together by one great dread.
It is that they might actually lose Obamacare both as something to rely on for health coverage and run against for cynical convenience.
I'd say they make me sick, but that's a pre-existing condition and I might need to move to Colorado in 2021 to get any affordable care.
Oh, wait, I'm on Medicare now. Single-payer. Lucky me.
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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at jbrummett@arkansasonline.com. Read his @johnbrummett Twitter feed.
Editorial on 04/04/2019