Back to the Future (Gwen Moritz Editor's Note)

by Gwen Moritz  on Monday, May. 15, 2017 12:00 am   3 min read

Donald Trump, desperate for a win that didn’t come with an asterisk because the Senate changed the confirmation rules, held a Rose Garden celebration when the House of Representatives barely approved a replacement for the Affordable Care Act that is 180 degrees from the promises he made to working-class Americans whose votes in key states made him president.

The Potemkin celebration didn’t surprise me: President Trump’s brand is all about the optics. Perhaps his true believers wouldn’t realize that he didn’t have a bill to sign — or what the bill he was celebrating would actually do to them and their families. It’s a cinch none of them knows how much it would cost or how many people it would affect because Trump and Speaker Paul Ryan, throwing yet another conservative tradition under the bus, couldn’t wait for pesky little details like that before insisting on a vote.

But, weeks later, I’m still trying to figure out the politics. Are House Republicans counting on Senate Republicans to keep them from actually sending millions of Americans back into the ranks of the uninsured? Or have Republicans looked at their November election results — seats lost in both House and Senate and the sixth second-place popular vote count in the past seven presidential elections — and decided that this may be their last chance to pull national policy back to the right before the liberals take hold?

Or could Robert Costa, political reporter for the Washington Post, have gotten it right when he tweeted that Republicans “believe they can perhaps blame [Senate Democrats] for any further stall. Tell base they’ve acted, rally for 2018.”

Blaming the other party is always popular, but it seems risky in this case. I can’t imagine that Democrats, slammed in highly effective 2012 campaign ads for cutting $500 billion from Medicare (in order to get more people insured), are going to let 2018 pass without reminding voters that Republicans voted to cut $800 billion from Medicaid while sending most of it back to high-income taxpayers. (Misleading? So was telling voters that Mexico would pay for a wall.)

President Trump’s premature exultation notwithstanding, Obamacare remains in place. It is as flawed as ever, but millions of Americans — including one in 10 Arkansans — are better off than they were without it. Senate Republicans have a rare opportunity, legislatively and politically, if they will seize it.

Consider: They no longer have to prove that they would never, ever make nice with Barack Obama, and they only have one Senate seat to defend in 2018 in a state that Hillary Clinton carried. Most importantly, Trump’s nomination and election should reassure them that GOP primary voters actually love big-government promises and care little about traditional conservative policies. (The biggest takeaway from 2016: Policy is overrated.)

If the goal is to fix Obamacare, Republicans can do that by re-embracing the individual mandate to buy health insurance. Yes, I know that the current Republican position is that no American should be forced to buy a commercial product (except auto insurance, obviously). But Republican voters are used to changing their deeply held convictions on command — just as they did when Republicans abandoned the original, conservative, Heritage Foundation idea that an individual mandate was the sort of personal responsibility that good citizens want to take on anyway. Stiffen the punishment for not buying insurance, bring the young and bulletproof into the system, watch the private-sector competition rebound.

This is not actually my preferred system. I remain attracted to the idea of mandatory, government-run catastrophic coverage for all legal residents of the United States, regardless of age, medical history or place of employment. It would be similar to Medicare for all, but with a very high deductible — I’m thinking $25,000 or thereabouts, but I’m not sure of the right number — so that it serves as a safety net rather than a first line of defense.

The private insurance industry could continue to operate below that level, with a variety of products available for individuals and families — even employee groups, if we insist on continuing the artificial connection between workplace and health insurance. (Admit it, employers. You’d be delighted to get shed of that responsibility.)

Higher-income folks could afford better insurance with lower deductibles. Lower-income families still might have to declare bankruptcy because they couldn’t pay the deductible, but the uncollectible costs shifted to the rest of us would be much smaller.

Yes, I’m talking about another socialistic government program like Social Security, Medicare and Medicaid — the ones candidate Trump repeatedly promised not to cut because it turns out that Republican voters actually love that kind of thing.

Gwen Moritz is editor of Arkansas Business. Email her at



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