Describing the Republican Party’s health care policy is, at one level, quite easy. The GOP has an irrational, overwhelming, all-consuming, wild-eyed hatred for the Affordable Care Act. Period, full stop.
But it’s every relevant detail after this where the troubles kick in. Republicans don’t know how (or if) to come up with an “Obamacare” alternative, despite over five years of behind-the-scenes efforts. Republican don’t know how (or if) to pursue a full repeal of the law. Republicans don’t know how (or if) to help those families who would suffer greatly if their efforts to undermine the law succeed. Republicans don’t even know how (or if) they should use the budget “reconciliation” process to go after the ACA.
Perhaps the most striking division, however, is between those in the GOP who are desperate to gut the nation’s health care system and those Republicans who quietly hope the law survives intact.
We learned last week, for example, that Iowa Gov. Terry Branstad (R) did not sign on to the Republican effort at the Supreme Court to destroy the ACA through the King v. Burwell case. A few days later, Nevada Gov. Brian Sandoval (R) devoted parts of his “State of the State” address to highlighting how great the Affordable Care Act has been for his state’s residents (though he neglected to credit the law directly).
The New York Times reported, meanwhile, that some Republican officials are actually afraid that their party might persuade Republican justices on the Supreme Court, with adverse consequences for everyone – including their own constituents.
After President Obama’s Affordable Care Act was enacted in 2010, Republicans at both the state and federal levels seemed to speak with one voice in flatly rejecting it.But in subsequent years, though most Republican governors remained critical of the health care law, nine accepted a central but optional element, expanding Medicaid programs to cover many more low-income residents of their states. At least four others, urged on by hospitals and business groups, will try to do so this year.And now, briefs filed last month in support of a major legal challenge to the law – King v. Burwell, which is now before the Supreme Court – are raising new questions about divisions within the Republican Party over the law.
Just how divided are they?
The numbers are striking: there are currently 31 states with Republican governors, and of those 31, only six have endorsed the litigation that hopes to unravel the federal system.
In contrast, during the original Supreme Court case that intended to destroy “Obamacare,” more than two dozen Republican-led states filed briefs with the high court, urging the justices to tear down the entirety of the law.
It’s possible these state GOP officials are holding back because they realize the lawsuit itself is idiotic, and they fear embarrassment through association. But it seems as likely that Republicans at the state level are simply aware of the practical realities: if the case succeeds, their constituents and state budgets will suffer badly. Worse, the pressure will be on them to help put things right for countless families, and they would just as soon skip the chaos altogether.
On the surface, Republicans at least keep up appearances about the King case, but just below the surface, where partisan and ideological crusades are less obvious, not everyone in the GOP will be rooting for a right-wing victory.