Why the GOP is in a bind on health care

July 26--Prognosticators on the right and the left predicted before enactment of the Affordable Care Act in 2010 that once the law was in place, opponents would find it exceedingly difficult to reverse course. Once millions more Americans became accustomed to receiving a government health care benefit, few politicians would dare take it away.

For once the chattering class had it mostly right.

After months of maneuvering and bluster, the Republican-controlled Senate voted Tuesday to begin debate on proposals to replace Obamacare with a stripped-down version of government backed health care that also permitted insurance companies in the private market to sell cheaper less comprehensive plans than those required under the Affordable Care Act.

But only hours later the Senate voted down a measure to do just that, 43-57. Among those voting against it were nine Republicans.

The Senate plans to take up the issue again Wednesday but will face the same agonizing political choice: some GOP senators from states that greatly expanded Medicaid coverage under the ACA are under political pressure to protect it. Medicaid traditionally was the government health care program for the poor, funded by state and federal governments. Under the ACA, the leading legislative initiative of President Obama's first term, the program was expanded to include millions more poor and working class persons.

According to a study by the Kaiser Family Foundation, enrollment grew 18 percent in the 31 states, including Pennsylvania and New Jersey, that expanded Medicaid under the ACA.

Tuesday morning the Senate was expected to vote on a second measure that would simply repeal the law, with a two-year window to craft a replacement, but that bill arguably faces a steeper political hurdle since it would entirely reverse the ACA's Medicaid expansion and result in even more people without insurance.

Why then are Republicans even bothering?

Because the politics of doing nothing could be more damaging that passing a bill. For years they've been promising to do away with Obamacare, calling it a blight on the economy. Turning back now would expose all of the GOP's earlier position as nothing more than self-serving political rhetoric.

Moreover, they need the savings they hope to glean from ACA cuts to finance ambitious tax cutting plans for later this year. Ever since the Affordable Care Act, was passed, GOP lawmakers have been telling voters the ACA was holding back economic growth. While President Obama repeatedly promised in advance of the ACA's enactment that it would contain costs while permitting millions to keep insurance plans and doctors that they liked, that hasn't turned out to be the case. Premiums have spiraled and many were forced into new plans once the ACA took effect.

Those were higher income persons who earned too much to qualify for even the expanded Medicaid program, but still qualified for assistance under the ACA. They purchased coverage from private health insurers through exchanges or insurance market places and received a government subsidy.

But the Medicaid expansion called for under the ACA was much more straightforward. Under the ACA, it was expanded and that apparently has created a political constituency.

Some GOP senators are now recognizing that.

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