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07/01/2012 Entry: On the PPACA Primal Scream
Last week, the Supreme Court, in a 5-4 decision, upheld the Constitutionality of the PPACA, commonly referred to as “Obamacare.”
Surprisingly, Chief Justice John Roberts was the deciding vote in the decision. More surprisingly, he initially voted against upholding the PPACA and changed his vote.
Unsurprisingly, the Republicans, who had been so bothered under the collar by the bill (which, ironically, was a policy they had originally championed), have been calling for a full repeal of the bill since the decision was handed down. Not that they have any plans to replace it (which they don’t); they just want the bill gone, no matter the consequences, and making sure the uninsured have access to affordable health care, according to Senate Majority Leader Mitch McConnell, “is not the issue.” The issue for McConnell, apparently, is in ensuring that the United States doesn’t have a European-style social safety net.
That said, I expect that the chorus of Republicans screaming about ACA repeal will die down within the next two weeks, probably once the House votes on a repeal bill that will go nowhere in the Senate. (Though, if I were Harry Reid, I might actually allow it to come up for a vote, if only for messaging purposes.)
There are two reasons I think this. First, the more they talk about repealing the health care reform, the more they sound, like Mitch McConnell did this morning, like callous, inhumane assholes. It’s an uncomfortable truth, but Republican elites consider health care a privilege, not a right. That’s a difficult position for Republicans to argue to their base because it lacks in human decency.
Cecond, while talk of repeal plays well to the base, it won’t play well with the corporate interests, especially with the insurance companies salivating at the thought of 30 million more customers that the Republicans say they want to take away from them. The thing about the PPACA is that it’s as market-friendly a universal health care plan as could be imagined. The government steps in to regulate the insurance companies to make sure there’s a level playing field, the government gives subsidies and tax credits to people who can’t afford insurance, and the insurance companies are the ones actually doing the heavy lifting. In short, the system that we have, dysfunctional as it is, is left intact; the difference is that the barriers that prevent customers from entering the market are lowered, if not outright removed. Repealing the PPACA takes away those customers and their money. Republicans can vote to repeal the PPACA now as a feel-good measure (and as red meat to their base), but if there were a serious effort to overturn the PPACA the insurance companies are likely to step in and say, “Hey, what about us? You’re not helping.”
If left alone, the Republicans will let this one go because it does them no good. Yes, railing against the PPACA will fire up the base, but it also puts Republicans on difficult rhetorical ground (as they discovered on the Sunday talk shows this morning) and it will alienate the corporate donors in the insurance industry. I think Obama is canny enough to not taunt the Republicans with the PPACA, and Mitt Romney knows, thanks to Massachusetts, that he has his own damage there. Two weeks, they’ll scream it out, and it’ll be done. That’s my guess.
I’m not so sure the insurance companies wouldn’t support a repeal. Sure, there’d be less customers because they’d lose the subsidies. But they also would be able to reject preexisting conditions and restore lifetime caps on coverage.
Either way will cost them money, the question is which one do they think will be more painful. Right now my money’s on them preferring a repeal, on the grounds that they’re better off with less regulation. But I’m not an accountant or actuary, much less one with knowledge of the health insurance industry’s costs, so that’s very much a gut feeling.