The ACA, also known as Obamacare, is vitally important to my family. My wife could very likely die if insurance companies were allowed to turn away people with pre-existing conditions. We also rely on Medicaid to pay for doctors’ visits and medications (thankfully we now live in Colorado- South Carolina still refuses to accept free money, so it was much more expensive in our previous home). Aside from climate change, health care is the most important issue to me. Naturally, I’ve spent a lot of time fighting to slow the GOP’s attempted repeal. I’ve repeatedly called my representatives. I went to Mike Coffman’s local office on a Monday morning to ask one of his assistants not to cut Medicaid, and there’s video of me telling him our story at his last town hall. It seems to have paid off, as he did eventually vote against the hideous monstrosity known as AHCA. Still, the damn thing passed the House by two votes, and now it’s up to the Senate to decide what to do. Health care has largely fallen off the radar in the wake of Trump’s alleged treason and confessed obstruction of justice, but it’s still a live issue. In back rooms in D.C., thirteen (male, mostly white)senators are writing their own version of AHCA, including my state’s Cory Gardner. It’s possible that they decide there’s nothing that will satisfy enough people to pass and quietly shelve the issue, but I wouldn’t count on it.
If I were Mitch McConnell- if I were a soulless Machiavellian who would stop at nothing to deliver for my corporate masters- what would my strategy be? Because he definitely has one. Paul Ryan and Donald Trump may be a pair of bumbling con artists who are in over their heads, but McConnell is a canny operator, and he plays the long game. Last year, he pulled off an unprecedented blockade of a Supreme Court nomination, and now we have Gorsuch on the bench, perhaps for decades. He knew how to ignore the short term media blowback and focus on the future. In that way, he was a perfect foil for Obama (the difference is that McConnell disdains compromise, while Obama was often conciliatory to a fault).
McConnell infamously started Obama’s presidency by devising a strategy of 100% obstruction. He knew that if any Republicans voted for an Obama policy then it would be seen as bipartisan, but things that pass with only Democratic votes could be portrayed as extreme leftist. Thus, we have the situation where Obama, Pelosi, and Reid desperately tried to compromise with Republicans to create a law that could get buy-in and still got no Republican votes. Anyone who understands policy knows it’s absurd to think of the ACA as ultra-left, especially compared to the health systems in other developed countries. Many still complain the the ACA is not leftist enough, which is probably true but it was also probably the best that could get through at the time, thanks largely to McConnell’s filibustering and the need to buy off corporate whores like Lieberman. Policy doesn’t matter in politics, though, so much as perception of policy. Many people do see anything that is supported only by Democrats will be seen by many as extreme left. On the other hand, the House’s repeal bill is extremely far right by any standard. It would take away health care from over twenty million people, possibly causing thousands to die. It was something of a relief when the Senate said they aren’t even considering passing the House bill, but they’re still going to try to pass their own. By design, the Senate is more moderate than the House, since senators have to appeal to whole states instead of gerrymandered districts. Still, I would assume whatever McConnell comes up with will be bad for a lot of people. Again, perception is what matters: the ACA will be perceived as far left, the AHCA will be perceived as far right, and McConnellcare will be somewhere in between. And we all know the mainstream media’s most infuriating framework: Both parties are to blame, and the truth is in the middle.
When I thought of that a few days ago, it was an instant epiphany. Of course that’s the strategy, and it shows that McConnell’s 2009 plan is still paying dividends. By portraying his plan as the sensible compromise between Barack Obama and Paul Ryan, fence-sitting politicians will be encouraged to vote for it. The media will say that Democrats are being partisan and obstructionist by fighting it. These pressures will make it that much more likely that the Senate passes whatever awful law they come up with. Then the House will feel even more pressure to accept a compromised version of their seven year long dream of repealing the ACA. It’s possible the Freedom Caucus will declare that it’s too moderate to accept the compromise, but I wouldn’t count on it. The ACA was passed in the Senate as a compromised version of the House bill, and then the House had to accept and vote for the Senate’s bill or else the whole enterprise would die. It would be fitting if the repeal happened the same way.
I am not writing this to say we’re doomed, though. The resistance has done a great job already. Remember Trump’s promise to repeal “on day one?” We’re four months past day one and the ACA is still law. Everyone credits this delay to the fierce pushback at town halls and through phone lines. We beat them once, but to do it again we need to focus on principles and not politics. If the focus is “save the ACA and beat Ryancare!” then I think we’re following a losing strategy. It might work, but that framing treats it as a game that we want to win, and that’s not a persuasive argument. Again, we don’t want to be portrayed as one side of a partisan tug-of-war with Paul Ryan, or else Mitch McConnell looks like the serious adult in the room. So I say we always emphasize why we’re fighting. Colorado has Medicaid expansion, and Cory Gardner has said he doesn’t want a law that cuts Medicaid. I plan to remind him of that. We don’t want Medicaid cuts, we don’t want people turned away for pre-existing conditions, and we don’t want any of the tons of other problems that the ACA fixed. We need to keep saying that now. We need to let them know that, while we’re not against any and all changes to health care, there are certain principles that cannot be compromised. Our ideas are popular. Let’s make sure we keep talking about them.