There is considerable consternation among conservatives that Republicans are about to snatch defeat from the jaws of victory once again, this time by trying to “fix” Obamacare–bowing to pressure from the media and other sources to take some joint ownership of a disaster that should just be allowed to happen.
The worry is that the bill introduced by Rep. Fred Upton (R-MI) to allow Americans to keep their individual health insurance plans would allow President Barack Obama to paper over his broken promises and to go back to implementing the single greatest entitlement and expansion of federal power since the Great Society.
Certainly Republicans have made that mistake before. Just last month, they rushed to offer a short-term hike in the debt ceiling, in a goodwill gesture that satisfied the media for exactly one news cycle. President Obama seized the opening to drive a hard bargain, and Democrats, sensing weakness, tried to cancel the sequester.
The Upton bill is different. And the divisions among Democrats reveal why. Those feeling the most pressure–moderates and those running for re-election in red states or swing districts–are supporting Upton’s bill, even after the president’s attempt to upstage it with his own bizarre administrative fix, announced Thursday.
Those most worried about the future of Obamacare, like House Minority Leader Nancy Pelosi, are rejecting Upton’s bill and searching for an alternative. The reason is that Upton’s bill would allow an individual health insurance market to exist alongside the Obamacare exchanges–a sort of “private option,” if you will.
Without millions of young, healthy, and/or middle-class people being forced to buy insurance through the Obamacare exchanges, the only people using Obamacare will be the poor and the sick. Prices will rise and the whole insurance market will destabilize. Obamacare will collapse and new legislation will be needed.
So Upton’s “fix” is not really a “fix” at all, except politically. As George Will noted, if Upton’s bill passes, there is no real need to repeal Obamacare: effectively, it will be repealed. That is why Obama threatened Thursday night to veto the Upton bill. But politically, he may not be able to stop Congress from overriding him.
It is becoming clear that repeal might be possible before 2016 or even 2014–but it might not look like full “repeal.” Democrats might be convinced to toss out most of Obamacare if they can retain the “security” parts of the policy–young people covered by parents until age 26, the Medicaid expansion, pre-existing conditions.
Indeed, Democrats are already starting to talk about the “health security law” rather than the “Affordable Care Act.” That suggests they are digging in against full repeal. But it also suggests the outlines of a possible compromise. Republicans could win a repeal in all but name only; Democrats could protect a few gains.
What would remain would be the rump of Obamacare–a few incremental (but significant) changes to the health insurance system, the sort of small changes that former chief of staff Rahm Emanuel tried to convince Obama to accept after Scott Brown won in Massachusetts. He refused then. He would be wise to agree now.