Sending the Health Care Debate to the States

After the 2016 election Republican moved into power by assuming the Presidency, preventing a liberal takeover of the Supreme Court, and holding both Houses of Congress. Additionally Republicans occupy 33 Gubernatorial offices and fully control 32 state legislatures. The seeds for those 2016 electoral victories were sewn back in 2010. In 2010 opposition to President Obama’s Affordable Care Act gave rise to the Tea Party movement. Republicans were able to successfully channel the energy of the Tea Party to take back the House of Representatives and many state legislatures. By controlling state legislatures in 2010 Republicans were in the driver’s seat when it came to the redistricting process that followed the 2010 census. Having gotten more favorable lines for congressional elections and state legislative elections Republicans reinforced their hold on power, setting the stage for the Republican takeover that came about in 2016.

Without Obamacare almost none of what I mentioned above would have ever been possible. Now Republicans are working to fulfill their promise of finally repealing the Affordable Care Act. As I write this the headlines are popping up about the American Health Care Act passing the House of Representatives. Regardless of how you feel about the AHCA as policy, I fear that while health care made our Republican government possible, it could also be the issue that leads to its eventually collapse.

I am not here to discuss the practical policy implications of the new law, only the possible political repercussions. The biggest repercussion that I see is in the consequences of shifting the fight to our state’s and state legislatures.

The American Health Care Act allows states to decide if insurers will be required to cover folks with pre-existing conditions or now. This means that every Republican Governor and every Republican legislature will be forced to grapple with this issue in a very public manner. As with any government entitlement it is much easier to give to folks than it is to take away. Going into the 2018 elections Governor and legislators will not be able to run on the issues that would have hoped to have run on because the Democratic political machine and the media will keep the spotlight on healthcare and the mean old Republicans who just want to take healthcare away from sick people.

Discussions over high risk pools or other conservative solutions for the pre-existing condition problem will be drowned out by “The Resistance” and their media allies shouting about how Republicans in their state are taking away protections from people that Obamacare provided.

Obamacare was a disaster on its way towards collapse and it needed to be repealed. I am glad the elected Republicans are finally taking the steps to do what we sent them to Washington to do and repeal and replace this law. I only fear that the way they went about it will have severe consequences for conservatives down at the state level.