Going all the way back to the first months of Barack Obama's administration, when the Tea Party rose up in the midst of the worst economic crisis in half a century to oppose heath care reform, I've been struck by the right's visceral loathing for the concept of expanding access to health insurance. There's almost a cultish component to this opposition, an apparent belief that health care is a devil's bargain of some sort that will doom America to burn in hell. When the Affordable Care Act was being debated in the long months of hearings and town halls back in 2009, its opponents worked themselves up into a frenzy of outrage over a market-friendly program that would allow people to have access to health care at a reasonable cost and wouldn't discriminate against sick people.
Did all the stories of suffering and financial ruin associated with lack of health care not move them at all? Did they believe it could never happen to them, that they or their loved ones could never lose their health insurance or go bankrupt from medical bills? Beyond the obvious fact that they hated President Obama and that their team was against government in general so they were too, I never understood the overwhelming rage this seemed to induce in so many Republicans. It exposed a streak of cruelty in some Americans that I have to admit surprised me.
Since last November's election the ACA has grown substantially in popularity. Nonetheless,the GOP majority in Congress is hellbent on repealing it even though they clearly have absolutely no idea what to do about the inevitable chaos that will ensue. It's a crusade whose purpose is no longer clear -- the act itself is apparently the goal.
At this point, Republicans aren't under particular pressure from the faction of their coalition one might expect to push for this repeal. Doctors, hospitals, insurance companies, many businesses and the AARP are all on record opposing the current GOP strategy. Some of their big ideological donors, including the Koch brothers, support repeal but don't seem to be making a huge deal out of it. The most loyal base supporters want it, of course. They also want a 2,000-mile border wall and think that Donald Trump is going to bring back the Industrial Revolution. But the fear of the Tea Party running primaries against anyone who fails to vote for this seems overblown at this point. That bubble burst. (Early indications are that Republicans are lagging far behind in candidate recruitment for the 2018 midterms.)
This is just a mindless drive for a "win," in order to justify a cynical political ploy that energized their voters to oppose the hated Obama and took on a life of its own. Now Republicans would rather see people's lives destroyed than admit to all that.
The Senate will vote on Tuesday whether to proceed to debate on a bill that nobody except Majority Leader Mitch McConnell has seen. For all we know, the bill doesn't yet exist. It's possible they will be voting on the Obamacare Repeal Reconciliation Act (ORRA) -- which is total repeal, causing 32 million people to lose their health insurance -- or the Better Care Reconciliation Act (BCRA), the Senate's "repeal and replace" bill that will cause 22 million to lose insurance. That latter bill has changed so many times that nobody has any idea what's in it. There are a number of provisions that have been rejected by the parliamentarian, some of which will result in a death spiral for the individual insurance industry -- although there's no reason to think Republicans care about that in the least.
Nothing matters at all except somehow getting to 50 votes in the Senate. And the truly astonishing thing is that through this entire chaotic process, the leadership has consistently had well over 40 votes, no matter what insane proposal it was contemplating. As Sen. Richard Burr of North Carolina said on Monday when asked if he was worried about what was in the bill, "it doesn't concern me. As I said, I'll vote for anything."
Late in the day it was announced that Sen. John McCain would return to D.C. today to cast a vote despite having just undergone brain surgery. Why GOP leaders could not hold off on this vote for a week or so to allow him to recuperate a little more is a mystery. They're in a big hurry to get this done. It is assumed that McCain would not return under such circumstances if he weren't going to vote for the motion to proceed, so that much is likely a done deal. Whether there will be enough votes for whatever monstrosity McConnell eventually gets to the floor is still unknown.
But as I wrote last week, even if this effort fails in the Senate, that's not the end of the story. Even more dispiriting, perhaps, President Donald Trump believes that such a failure has a silver lining since he can then sabotage the existing Obamacare law and "blame it on the Democrats," which he believes is smart politics.
According to the Daily Beast, the administration is already using money designated to encourage enrollment in Obamacare to spread propaganda against the program and urge people to push their congressional representatives to repeal it, which is against the law. Your tax dollars are being used to fund the cynical partisan work of the Trump administration and the Republican Party. That's just for starters.
As Ian Millhiser of Think Progress explains, due to some complicated legal issues, it's possible that the Trump administration will simply stop paying the subsidies that make the Obamacare exchanges work. They could basically pull the fiscal plug, and that would be that. Politico reported last week:
Trump has repeatedly told aides and advisers that he wants to end the subsidy payments, and he has not changed his position, according to several people who have spoken with him. “Why are we making these payments?” Trump has asked.
This will throw the Obamacare exchanges into turmoil and chaos, which is evidently something he would very much enjoy. Polling shows that six in 10 Americans will blame Republicans for the catastrophe, but bear in mind that Donald Trump's entire life has been organized around blaming others for his mistakes, so he's confident he can pull this off too.
Tuesday is going to be a dramatic. If this latest attempt at repeal goes down in flames in the Senate, Republicans may have to table their dream for a little while. But they'll come back with something. It's a fixation. And until they do, Trump will have his henchmen do everything in their power to undermine the existing program. Either way, these people are going to ensure that the poor and middle class who have the bad luck to need Medicaid or individual insurance will pay the price.