On Health Care, Republicans Are Caught Between a Rock and a Hard Place


The New York Times reports that the Koch brothers are about to unleash the hounds. They. Have. Had. Enough:

Saying their patience is at an end, conservative activist groups backed by the billionaire Koch brothers and other powerful interests on the right are mobilizing to pressure Republicans to fulfill their promise to swiftly repeal the Affordable Care Act.

….The sudden caution of the Republican Party leadership, as it grapples with the enormously complicated challenge of replacing the Affordable Care Act, has baffled conservatives who have been fighting the health law for years. In the House, Republicans have voted dozens of times to dismantle the law, and it has been a primary issue in congressional races since 2010. Repealing the law, many conservative lawmakers believe, is the one clear mandate they have from voters.

….The repeal effort by the conservative groups is intended to sway members of Congress who may be hesitating because of public pressure back home. That pressure, conservatives said, is no reason to renege.

Talk about clueless. Sure, constituent pressure is having an effect, but it’s nowhere near the biggest issue here. The biggest issue is that after voting to dismantle Obamacare dozens of times when they knew it was just a symbolic protest vote, Republicans suddenly have to think about what will happen if they dismantle it in real life. Answer: they now have to admit that they can’t dismantle the whole thing. They never fessed up to that before, so it’s no wonder the base is confused, but the House and Senate leadership have always known it. They can only dismantle the parts related to the budget because Democrats can filibuster the rest. And if Republicans dismantle only half the law, it will probably destroy the individual insurance market.

Oops. That would be bad, even by Republican standards. Plus there’s the fact that millions of people would lose coverage, which is bad by centrist voter standards, even if Republicans don’t really care about it. In other words, the GOP leadership is finally having to face up to the fact that repealing and replacing Obamacare is a tough nut to crack. Centrists will abandon them if they cause chaos, but hardliners will abandon them if they spend too much money. That’s why they’ve agreed to modify their current plan to exclude subsidies for the well-off:

The concession on tax credits is a middle ground between what conservatives were demanding and what leadership wanted. Freedom Caucus Chairman Mark Meadows (R-N.C.) and RSC Chairman Mark Walker (R-N.C.) in recent weeks came out against the GOP plan to replace Obamacare tax subsides with advanceable health care tax credits.

They preferred a tax deduction that would not allow those who don’t pay taxes to receive a check in the mail, calling such “advanceable” credits a “new entitlement.” At the crux of their concerns is the price tag, which they worry would increase the deficit.

A tax deduction, of course, would be useless to the poor and working poor, the very people who need help the most. But the Freedom Caucus doesn’t care about that. Luckily for them, their leadership understands just what a political disaster that would be.

In any case, the Freedom Caucus is right about one thing: advanceable tax credits are a new entitlement. Or, more accurately, a continuation of an old entitlement. There’s really not much difference between Obamacare’s subsidies, which are paid directly to insurance companies, and Ryancare’s tax credits, which are paid to the taxpayer, who then pays the insurance company.

As for the deficit, well, Ryan’s plan will only increase the deficit if Republicans also repeal all of Obamacare’s taxes and then decline to pass any new ones. Which they will. So that’s a legitimate complaint too.

As usual, it all comes down to money. That’s really the only thing that matters.