With the Republicans’ health care bill in crisis, some have suggested they try a bipartisan approach. To understand the prospects of such a thing, recall the most important political distinction about health care: Republicans hate Obamacare, but they are mostly indifferent about the Affordable Care Act.
Yes, I know, Obamacare is the Affordable Care Act. But it’s a distinction that makes sense anyway. “Obamacare” is the most evil legislation in the history of the galaxy, featuring death panels and, well, the details get fuzzy after that, but it’s definitely a disaster, one that absolutely must be fully and totally repealed.
The Affordable Care Act is a complicated law that contains a wide variety of provisions, many of them traditionally supported by Republicans. No one is demanding to eliminate, say, the provisions that have encouraged the switch to digital medical records.
Indeed, ever since 2013, when the law was fully implemented, “repeal” has been a nonsense idea. “Repeal” implies a return to the status quo, but that world is simply gone. Republicans could replace the current health insurance system with something very different or with something broadly similar, but they can’t go back to January 2009.
That’s not to say there isn’t a profound difference between Republican conservatives and Democratic liberals on health care. There is, but it’s one over the fundamental responsibility of government to enable (almost) everyone to have some sort of health coverage, be it private insurance, public insurance or some mix of the two. And that’s an argument that Democrats appear to have won for good in 2009, and that Republicans don’t even want to fight – thus Republican efforts to portray Medicaid cuts as somehow harmless and not even cuts after all. (Yes, it’s a “cut” if the law is changed in order to spend less money. End of story, really.)
At any rate, while a few Republicans are willing to say publicly that it’s just tough luck if people don’t have any insurance, most of the party claims they’re trying to cover more people, not fewer, and to provide better, cheaper coverage, as if that was the proper role of the government.
As I said, the argument is to a large extent over, although whether people will actually have available, affordable coverage is up in the air whether the Republican plan passes or not.
What all this means for the politics of health care right now is that a bipartisan approach can only help with fixing or improving the Affordable Care Act; choosing bipartisanship would almost by definition be a total surrender of the goal of “repeal and replace,” at least as long as Democrats say they want to keep Obamacare in place.
The split between the Affordable Care Act and Obamacare gave Republican leaders a large opportunity: They were in a perfect position to define Obamacare however they liked, and most Republicans (except for a handful of true ideologues and a perhaps larger handful of contrarians) would go along. That’s pretty much what happened, but instead of defining it in a way that made it easy to reach 218 votes in the House and 50 plus the vice president in the Senate, Paul Ryan and Mitch McConnell defined repealing Obamacare as slashing Medicaid, which is a very difficult sell to even Republican members of Congress.
The funny thing is, they probably still could go back to the drawing board if they wanted to and entirely redefine Obamacare again, but at least so far they don’t seem interested.
There’s just no way that repealing and replacing Obamacare can be bipartisan. So until and unless Republicans give up that goal, they’re not going to even try to work with Democrats.
Jonathan Bernstein is a Bloomberg View columnist. He taught political science at the University of Texas at San Antonio and DePauw University. Readers may email him at email@example.com.