Thom Tillis' awkward Obamacare dance: It's the worst law in history, except for its central purpose

The NC Senate candidate hate hate hates Obamacare! (Though he loves the main part of it)

Published October 8, 2014 5:00PM (EDT)

Thom Tillis                      (AP/Gerry Broome)
Thom Tillis (AP/Gerry Broome)

Must Thom Tillis feel lonely, or ashamed? He's the only Republican challenger to an extremely vulnerable, cookie-cutter Senate Democrat in a purple state who's trailing. That's just embarrassing. How's he going to explain that one to the guys at the bar? They'll never let him hear the end of it.

Tillis went into fully desperate spaghetti-flinging comedy mode in last night's North Carolina debate with Sen. Kay Hagan. He prattled on about the "liberal activist judges that are literally" -- literally -- "trying to legislate from the bench" and blamed Hagan for confirming them. He criticized her for missing committee hearings, a popular and easy line against incumbents this year, because every senator will miss hearings. Tillis also pulled out the ISIS-Ebola twofer -- still in Republican attack-machine beta testing, for tweaking -- arguing that "the current handling of Ebola is 'another failure like the failure [on] ISIS, and a number of other policy issues where our safety and security is at risk.'" Not quite the ISIS-Ebola-Mexicans triple axel that Tom Cotton's perfecting in Arkansas, but there's no need to expend your entire arsenal at once.

And of course, Obamacare. There were several of Senate debates last night, and the Republican candidates appear to have settled on a specific "...that has ever been passed in the history of the United States" focus-grouped hyperbole to express their hatred for the health care reform law. In Georgia's debate, David Perdue described the Affordable Care Act as "one of the worst laws that has ever been passed in the United States’ history." Tillis' variation: the ACA is "one of the most disastrous regulatory frameworks that has ever been passed in the history of the United States."

But then Tillis had this gem to offer, according to The Hill (emphasis ours):

Tillis slammed ObamaCare as "one of the most disastrous regulatory frameworks that has ever been passed in the history of the United States," but said he agrees with the planks that ensure coverage for those with preexisting conditions and allow Americans 26 and under to get covered on their parents' plans.

According to Tillis, the Affordable Care Act is the crown jewel of shite legislation, although he does sort of like that part about guaranteed issue for people with preexisting conditions -- also known as the chief selling point and central purpose of the law. It's a little bit more than a "plank," something just tossed in there with other assorted marginalia.

Tillis' attempt to have it both ways plays into a misguided belief that the Democrats who drafted the Affordable Care Act made it complex for the purpose of making it complex. That complexity was the end goal in and of itself. If they wanted to ensure coverage for those with preexisting conditions, they could have just inserted a line to that effect and left it there. But instead they had to throw in all these exchanges, mandates, paperwork, yadda yadda yadda.

If guaranteed issue for individuals with preexisting conditions were an easy thing to put into law, it would have been put into law decades ago. But it would also rapidly destroy the health insurance system, left on its own. Sick people would sign up for health insurance in droves, driving up premiums, causing young and healthy people to cancel their insurance, sending premiums into a "death spiral," crashing the market.

The Affordable Care Act guarantees health insurance for preexisting conditions through mandates to keep insurers' risk pools balanced and subsidies for people to manage out-of-pocket premium costs. The law isn't a Rube Goldberg-type contraption because Democrats view complexity as legislative sport; it's because trying to provide universal health care while maintaining a private health insurance industry isn't a straightforward task. There is a simpler path to providing universal health care: the private health insurance industry is wiped out, people pay more in taxes, you walk into the doctor's office to get whatever you need, and the government pays the bill. But Tillis et al. would object to this as Red Communism, so.

The Republican party is lucky. Most likely it will never get the filibuster-proof numbers in the Senate and the right Republican in the White House that it needs to execute its goal of repealing the Affordable Care Act. In that vacuum, the Republican party would face pressure to figure out another way to guarantee health insurance for people with preexisting conditions, and it does not have one.

By Jim Newell

Jim Newell covers politics and media for Salon.

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