GOP Health Care Smash-Up: Part One

The GOP has promised its base that it will defund the individual mandate, and it has promised health insurance companies that it will strengthen the mandate. Something has to give.

Robert Pear’s NYT story the other day about Republican efforts to repeal health care reform contained this evocative nugget close to the lede.  The Republicans acknowledge that they cannot repeal the Affordable Care Act because of a Presidential veto, but will try to do it indirectly in other ways:

Republican lawmakers said, for example, that they would propose limiting the money and personnel available to the Internal Revenue Service, so the agency could not aggressively enforce provisions that require people to obtain health insurance and employers to help pay for it. Under the law, individuals and employers who flout the requirements will face tax penalties.

I’d like to see them try.  Really: I’d like to, and here is why:

Yes, the Tea Party is outraged by the individual mandate.  Yes, politically ambitious GOP state attorneys general are suing over its constitutionality. 

But you know who loves the mandate? Health insurers.  And they poured millions into GOP coffers during the campaign, mainly because they think that they have persuaded the GOP to strengthen the mandate.

And you know who doesn’t love the mandate?  Barack Obama. Recall that during the presidential campaign, he criticized Hillary Clinton’s plan for including one.  Apparently, he was (is?) concerned that we’ll get a mandate without adequate subsidies.

If Obama and the Dems play this right, this could leave the House GOP in a bind:

1)  They insist on defunding mandate enforcement, and they cut off a big contributor constituency; or

2) They back off from defunding mandate enforcement, enraging the Tea Party and generating dozens of primary challenges; or

3) They insist on defunding mandate enforcement and Obama agrees.  If there is an agreement, that’s the worst of all possible worlds — any agreement will tick off the Tea Party, and defunding mandate enforcement will tick off the insurers, sticking them with antidiscrimination regs but no mandate.

So obviously, the GOP will try to make their appropriations riders as unappetizing as possible for Obama.  But then Obama can use his megaphone, saying that he’s ready to back off the mandate and the GOP won’t let him, again splitting the base.  And why won’t they let him?  Because they insist on defunding the popular parts of the ACA, like anti-discrimination and anti-rescission provisions.

The weak link on this is that the GOP will try to couple defunding the mandate with defunding the exchanges, which will help working people but no one understands, and thanks to Steaming Pile of Senator Kent Conrad, don’t kick in for a while.  Still, Obama can say he’s ready to stop the mandate if the GOP is, which it won’t be because the insurers won’t let it.

In all, it will be interesting to see how the GOP will try to continue to serve the insurers while at the same time keeping Tea Partiers off its back.  It will be able to count on key support from the media, which will lap up its spin.  But still, it’s hard to promise two key constituencies two diametrically opposed things.

The other weak link is the requirement that Obama and the Dems play this right.  As someone said the other day, these guys couldn’t sell cocaine to Charlie Sheen.  But the GOP has a problem with this, and Obama’s strategy should be to ensure that as many people as possible know about it.  Besides, if we get rid of the mandate, then this might actually put enough pressure on the system that we’ll have to have a public option, which would be a great and ironic outcome down the road.

Author: Jonathan Zasloff

Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees. Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses. Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.

17 thoughts on “GOP Health Care Smash-Up: Part One”

  1. Henry,

    The exchanges, if funded, will help working people by offering them subsidized health insurance if they don't already have coverage through their employers.

  2. At this point, I despair of the Obama team having anything close to the smarts to embarrass Republicans. May Pelosi is the only one with teh political nous to spot the opportunities and exploit them.

  3. I too doubt any plan that includes "if the Dems play this right". Its not as if history is on their side.

  4. Dan Staley: History is the only thing on the Dems' side. Demography, health costs, international competitiveness, justice, logic … The Republicans, having strong party discipline, limitless corrrupt funding, a tame media, and no principles, will win all the tactical fights (cf, the impending cave-in on DADT). But in the long run, they are lost.

  5. Henry,

    The "exchanges" seem to be modeled on the Federal employees health insurance system. Federal employees can choose their health insurer from a truly dizzying array of options. The options vary, depending on where you happen to live. The idea is to create a very large pool of purchasers and allow insurers to offer health insurance products to the pool. Once a year, everyone who wanted to change plans would be able to do so.

    There are subsidies included in the "exchanges", but it isn't entirely clear to me how they are supposed to work.

  6. It's easy for academics to bemoan the Democrats' lack of political smarts, as they praise them for their policy smarts. That's because academics are pretty good at policy. Politics? If you academics are so smart, why haven't you run for office?

  7. James Wimberley:

    I appreciate that you think the tide is slowly turning. I want to agree with you, but 30+ years of closely watching this stuff, having an ecological education, and having a father who was a campaign manager perhaps makes me too tired and pessimistic.

    Regards,

    DS

  8. James,

    I'm too dense to understand. Kim Il-sung ruled North Korea from 1948 to his death. Leadership was successfully passed to his son, Kim Jong-il who is the current leader of North Korea. Unless some drastic change occurs upon his actual death (as opposed to his prolonged illness), Kim Jong-un is going to take over. Given that officially life expectancy in North Korea is in the 60's, that means that the vast majority of North Korea's "historical" perspective is of a Kim in charge. Any appeal to historical trends that suggested otherwise is contradicted by reality. (And as long as I have been alive, I have heard confident predictions that both Cuba's and North Korea's governments are unsustainable.)

  9. I'm sorry, but I don't see how ANYONE wins as we attempt to create a nation of scofflaws.

    Once you create an environment where it is considered reasonable and patriotic by 35%+ of the population to cheat on their taxes (insofar as this compulsory insurance crap we've had forced upon us both feels like a tax and will be administered as such — yay for tax farming) you think it will end there? It's one thing for a tiny community of hippies to refuse to pay taxes because they disapprove of the pentagon budget — it's another when 35% of the population are doing this, and encouraging the rest of us to think the same way. "You know, why SHOULD I pay my full taxes — I thought the war on terror/iraq/afghanistan/sanity was a dumb idea from the beginning. And I don't care about the wall street bailout. And I don't see why I should have to subsidize other people's house. So let's see — I think about 50% of my current tax is a fair amount to report."

    Has it really come to this, that the GOP is willing to publicly encourage the entire country to explicitly break the law, and the rest of the country is willing to stand by and ignore the long-term consequences of this sort of thinking? Is the plan that we want to be Greece by 2030?

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