At some point, hopefully in the not-too-distant future, we’ll start treating candidates’ statements on the Affordable Care Act as policy positions rather than just political arguments. The moment we start doing that, we’ll be quick to discover that quite a few candidates – mainly Republicans – hold positions that are contradictory and incoherent.
For the longest time, the standard take on Obamacare in closely contested midterm races has been that it is toxic for the Democrat and an effective weapon for the Republican, owing to the general unpopularity of the law and the president who passed it. The ACA’s absurdly problematic rollout only helped to cement that bit of conventional wisdom, and any Republican candidate could easily limit their position to “repeal it now!” and be reasonably confident that reporters would be more interested in pressing Democrats for healthcare specifics.
Now that the law is in place and people are benefiting from it, that dynamic no longer applies; Republican candidates are trying to soften their positions a bit while sticking true to the “repeal” message conservatives want to hear. The result is a contradictory policy position that steers comfortably clear of any specificity.
Thom Tillis, North Carolina’s Republican Senate candidate, served up a fine example of this Obamacare incoherence during an interview with the Washington Examiner’s Byron York. North Carolina is turning out to be an interesting Obamacare case study. Tillis and the state’s Republican governor, Pat McCrory, led the charge in fighting the law’s implementation by refusing to set up a state-based exchange and denying federal money for expanding Medicaid under the ACA. (Tillis aired radio ads during the GOP primary boasting that he “stopped Obamacare’s Medicaid expansion cold.) Even still, residents signed up in droves; North Carolina had “the third-highest rate of enrollment among states that decided not to set up their own exchange,” per Politico. And McCrory signaled last month that a compromise package for expanding Medicaid could be possible: “I’m leaving that door open.”
Asked about the Affordable Care Act by York, Tillis offered the standard Republican response: “I think we have to repeal it.” OK, so, get rid of it entirely, right? That’s generally what “repeal” means, so he must favor its complete annihilation from the books.
Tillis is under no illusions that the GOP, even if it controlled the House and Senate, could actually repeal Obamacare with its namesake still in the White House. And even after, given the structure of exchanges and subsidies that now exists, repeal can't be done in one fell swoop. "I think you're going to have to ramp it down," Tillis said. "Any repeal measure needs to be married with how do you provide a landing, or a transition, to some of those who are on Obamacare."
So “repeal,” but not for the people “who are on Obamacare.” At least not all of them – “some” will be allowed to retain their coverage, but only for a transitional period. Maybe.
At this point, it would have been nice if York had actually pressed Tillis on what this would mean, how it would be implemented, or what the “landing” or “transition” would look like. But he didn’t. Either way, Tillis’ position on Obamacare is now “repeal, but not all the way.”
For its lack of specificity and its promise of bureaucratic and legislative nightmares, this argument is actually fairly common among 2014 Republican Senate candidates. Mitch McConnell, who is fighting off a challenge from Democrat Alison Lundergan Grimes, staked out a contradictory and untenable position when he suggested that Kentucky’s popular Kynect insurance exchange would not be affected by the repeal of Obamacare. In New Hampshire, Scott Brown floated a unique idea a few months ago: repeal Obamacare, but do it in such a way that beneficiaries in New Hampshire would be “grandfathered in” so as to not lose coverage. A campaign aide tried to undo the damage by flatly contradicting her candidate: “You can’t grandfather people from something you’re fully repealing.”
All this points to a slate of candidates who settled on an ideologically friendly message and are finding it difficult to adapt to the real world. Of course, a lot of the tension would evaporate if Republicans had plans for what should replace Obamacare after they repeal it. In talking to York, Tillis said as much:
Tillis is concerned that Capitol Hill Republicans haven't united behind an Obamacare alternative. "Republicans have to have an answer to the when-you-repeal-it-what-are-you-replacing-it-with question," he said. "We owe the American people a solution to the problem."
At this juncture, you might be tempted to ask why Tillis, as someone actively trying to become a “Capitol Hill Republican,” doesn’t propose and run on his own replacement plan for the Affordable Care Act. Well, he already answered that question: “’I don’t think I need to come in with a plan,’ he said in a recent interview. ‘I think we need to take a look at the ones that already exist and build on those.’”