After nearly a decade of manipulating the political system in order to undermine the Affordable Care Act (ACA), widely known as "Obamacare," it seems that Republicans are on the verge of getting their way. A new court challenge demanding a full overturn of the ACA suddenly appears to have a chance of succeeding. On legal merits, the challenge is ridiculous and should, in a sane world, have been thrown out long ago. But Republicans have spent years packing the courts with right-wing ideologues and demonizing this signature Democratic legislation. So the stars have aligned and the already rickety American health care system is in very real danger of falling apart.
In a twist worthy of one of your better fairy tales, however, Republicans seem worried about the victory they've worked so hard to achieve. It was one thing to demonize Obamacare back when most voters had no idea how it worked. The Republican base knew only that it was tainted by its association with the first black president, and that was enough. But now that people are experiencing the benefits — subsidies, easier access to Medicaid, regulations that make private insurance more manageable and effective — they're not going to be happy with the party that takes it all away.
Now the GOP faces a dilemma that is turning wealthy white elitist against wealthy white elitist: How can they take away people's health care without those people getting mad about it? Is such a thing even possible?
It appears Republicans are sorting into two camps on this question. The first camp, the realists, believe that while it's easy to snooker people with lies about immigration or terrorism, people tend not to be as easily deceived about whether they've lost their own health insurance. The second camp, the BS artists, believe they can bamboozle people, especially white people in red states, about anything. Essentially, they think that if you tell those folks that they're getting health insurance, they may not notice that they don't actually have it.
Unsurprisingly, the B.S. artists are being led by Donald Trump and his chief of staff, Mick Mulvaney, who pushed for the Department of Justice to back a lawsuit meant to overturn the ACA in its entirety. If this move works as intended, it will at least 21 million Americans will lose health insurance, and possibly far more, when taking into account ACA provisions requiring plans to cover pre-existing conditions and young people up to 26 on their parents' plans.
Trump's strategy for dealing with this problem is straightforward: Lie about it and hope that his base voters love him so much they agree to believe the lie, even as their health care access disappears.
"If the Supreme Court rules that Obamacare is out, we will have a plan that is far better than Obamacare," Trump told reporters on Wednesday from the Oval Office.
Vice President Mike Pence's office has joined in, sending out an aide to tell reporters that the "president will be putting forward plans this year that we hope to introduce into Congress."
Trump went so far as to hold a phone conference with Republican senators Tuesday, during which he encouraged them to come up with a replacement plan for Obamacare.
All this maneuvering, however, needs to understood strictly as theater, meant to hoodwink voters into thinking that Trump wants to save their health care. Of course, he has no plan to do that, and there's no reason to believe he truly intends to come up with one. Even if Trump does have some vague idea that Republicans can just toss out Obamacare and then pass a new bill that is basically Obamacare under a different name, there's no indication that he or the members of his administration are interested in actually doing the work required to make that happen. So this should all be understood as an effort to trick people into not noticing that health care is suddenly a lot harder to get.
Congressional Republican leaders, on the other hand, understand that they lost 40 House seats in last year's midterms largely because of health care. They seem skeptical of the idea that you can bamboozle the public quite this much. House Minority Leader Kevin McCarthy reportedly tried to talk Trump out of backing the wholesale destruction of Obamacare, arguing that it would be politically disastrous. Senate Majority Leader Mitch McConnell, while not trying to save the ACA, has also washed his hands of the whole thing, telling reporters, in so many words, that if Trump wants a new health care bill, he can write it himself.
McConnell and McCarthy have been happy enough to lie in the past about other issues, so this aversion to Trump's strategy is likely rooted in skepticism that the masses can be convinced not to notice that they lost their health care access. While these leaders may be perfectly happy to push millions of people out of the health care system, at least they won't pretend that doing so comes without political costs.
How much this will matter in the polls, at the end of the day, is still uncertain. McCarthy appears to believe Democrats won the majority in the House of Representatives in the midterms because of the continued Republican attacks on health care. McConnell appears more sanguine, believing he can cancel health care for millions and base voters will stick with Republicans because of their tribal hatred for Democrats. Trump, ever the narcissist, seems to believe he can tell transparent, laughable lies and his base will eat it up out of loyalty.
We can hope that this latest court case against the ACA will fail, and all these differing opinions on what wins elections for Republicans won't be tested. But if it comes down to it, odds are that McCarthy's closer to being right than Trump is. A lot of voters are willing to gulp down lies about immigration, terrorism, and crime because they have no personal experience with these things and are pretty much ready to believe anything. But losing your health care access is something that's hard to ignore. And on this timeline, it might even happen before the 2020 election.