With abundant justification, I could spend this column obsessing over the various evils and sundry scandals perpetuated by the Trump administration since our last visit: Attorney General Jeff Sessions' despicable attacks on transgender students and recreational marijuana, not to mention his renewed embrace of the contemptible for-profit private prison system; Chief of Staff Reince Priebus' possibly illegal request to the FBI to knock down reports that Trump campaign officials were in contact with Russian intelligence operatives, which the FBI declined to do (a series of events that naturally culminated in President Trump attacking the FBI on Twitter); the Department of Homeland Security's move to massively broaden the scope of potential deportations and reports that the president's team is looking for ways to neuter the popular Deferred Action for Childhood Arrivals program; Trump himself ominously threatening to "do something" about the media he so dislikes.
But, to be honest, I have something approaching outrage fatigue. I've been angry so much I've worn myself out. (It's only been six weeks. This is going to be a long-ass four years, or at least a long-ass however many months before the GOP Congress gets tired of Trump's shit and deposes him.) So instead I'd like to turn to an actual bit of policy, and perhaps one of the few glimmers of light in this otherwise dark storm: Obamacare.
Which isn't to say that I'm particularly thrilled to see what a generally amoral, unified conservative government does to the first tepid steps this country has taken toward joining the rest of the developed world with an actual universal health care system. Rather, I'm terrified.
I have an employer-sponsored plan now, but it wasn't so long ago that I was a full-time freelancer, and the Affordable Care Act's exchanges offered me reasonable options, even without subsidies. They've done the same for millions of others, most of whom do have access to those subsidies and are thus sheltered from the inevitable premium rate hikes that come year after year. In the states that have expanded Medicaid – not Florida, which hates Obamacare so much that it is purposefully cruel to the less fortunate – tens of millions more have benefited, as the expansions allowed those who previously earned too much money to qualify for Medicaid but too little to qualify for Obamacare subsidies access to care.
The plan isn't perfect, of course – insurance companies are avaricious to their core, and anytime you sublimate something like health care, which does not lend itself to consumeristic choice the way that, say, shopping for an HDTV does, to the whims of the profit motive, you're going to have conflict that rarely resolves itself in the consumer's favor. This is, in its most simplified form, the argument for single-payer, or at least a public option: that health care is a right and access to it shouldn't be determined by the size of one's wallet. But, it suffices to say, in this political climate, that's not the conversation we'll be having.
Rather, the Republicans now have the opportunity to do what they've been promising to do for the last seven years, should voters grant them the total control of Washington they received in November: repeal and replace. The first part is easy enough. When President Obama was in office, the Republican-led House took dozens upon dozens of Obamacare repeal votes, so many that it became a running joke. But it's that second part – the hard part, the actual governing – that has proven nigh impossible.
In a sense, the Republicans in Congress have become the proverbial dog that caught the car. It's easy to rail against a piece of legislation, to highlight its shortcomings, to pick out any piece of bad news and proclaim that the sky is falling. It's much more difficult to find something that covers as many people – and covers people with pre-existing conditions and without lifetime coverage caps – and does it for less money and with fewer regulations, which is what Republicans profess to want. That's because all of the ACA's unpopular pieces (e.g., the coverage mandate) are designed to ensure that its popular ones are viable, and they can't find ways to keep the things people want without keeping the things they've been criticizing all along. Weird how that works.
So as they go about devising a replacement strategy, Republicans are running headlong into this quandary. They've promised their base a repeal, but reinstituting pre-existing condition restrictions will be a nonstarter with the white suburbanites they'll need in 2018. And now, at town halls across the country, members of Congress – at least the ones brave enough to face their constituents (ahem, Marco Rubio?) – are being met by citizens worried about losing health care when they need it most, when their spouse or their kid has cancer. These are heartrending stories, the kind that pull back the political veil and reveal the very human cost to the cold calculations being made on Capitol Hill.
Not coincidentally, as Republicans are publicly weighing their replacement options, support for the Affordable Care Act is nearing its all-time high, according to the latest Kaiser Family Foundation tracking survey. The numbers aren't overwhelming – 48 percent have a favorable view, while 42 percent have an unfavorable one – but consider this: Last April, 49 percent of American adults had an unfavorable impression of Obamacare, while just 38 percent liked it. That's a heady improvement in less than a year, and it's taken off since Trump has taken over.
In short, the closer we get to the Republican replacement, the better we like the old system. And that's why repeal and replace was never going to happen, as former House Speaker John Boehner admitted last week at an Orlando health care conference: "I shouldn't have called it repeal and replace because that's not what's going to happen. They're basically going to fix the flaws and put a more conservative box around it."
That's assuming they can do that without screwing it up. After all, the dog that catches the car gets hit.
Even President Trump seems to have realized that reinventing a massive health care system – something Trump promised to do during the campaign on day one of his presidency – is more complex than he imagined it to be, saying Monday: "Nobody knew that health care could be so complicated." Huh. Weird.