The GOP’s “Patient Choice, Affordability, Responsibility and Empowerment Act, or CARE” seems like a more timid and more market-oriented Obamacare, creating some reforms but stopping short of a total overhaul. “It checks a lot of the same boxes as the ACA, but doesn’t go as far,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, said.
Reading it through in some detail yesterday, I was a little floored. After all the hysteria about Obamacare ending America as we know it, about its terrifying impact on the very nature of our polity, its devastating blow to the economy … the GOP’s alternative looks a hell of a lot like Obamacare – but with some gratuitous unconcern for some of the most vulnerable.
I think this new proposal, while certainly a substantive step forward, is so similar to Obamacare in so many ways, it effectively ends the real debate over it – although the rhetorical histrionics will no doubt endure. Any proposal that seeks to expand access, end the pre-existing conditions Catch-22 and control costs, turns out to look, in practice, much, much more like Obamacare than anything that preceded it. Once that is absorbed out there and the debate becomes a real one between actual alternatives, as opposed to an abstract one about America’s identity, the GOP is immediately on the defensive. The voters may well decide that if they’re going to get some version of Obamacare, better the real thing than an incoherent and vague knock-off. Or they may even decide that the GOP’s hysteria was bullshit. Because it was.
Frakt doubts the GOP’s bill will go anywhere (or was ever meant to):
Title 1 of the Patient CARE Act repeals Obamacare to provide “needed relief from job-crushing mandates.” That’s all it does. That’s its sole purpose—on paper. But Title 1 isn’t really there, on paper, to repeal Obamacare. It’s there to satisfy the need of GOP candidates to appear to be against everything actual and implied by Obamacare on the campaign trail and in primary debates, if not those for the general election. It’s there so that more moderate GOP Senators and Representatives can say they have a reform plan, but still minimize the risk they’ll be challenged on the right by a Tea Party candidate who is “really” for repeal.
Meanwhile, Democratic candidates, by and large, cannot be for repeal. Obamacare is their law, and explicitly so if they voted for it. Therefore, it hardly matters if the Patient CARE Act is similar in many ways to the ACA. No Democrat can be for anything that begins with repeal no matter how similar the guts are to the ACA (whether initially or after some compromise). That’s admitting political defeat on the ACA and handing victory to the GOP. Why would Democrats do that?
They won’t. They won’t today. And they won’t after the midterms. There’s no compromise here. One side needs to be for repeal, for political reasons. The other side cannot be, again for political reasons.