The GOP’s Obamacare cliff is closer than they want you to believe

During the budget wars of the Obama administration, congressional Republicans regularly courted national disaster by forcing fiscal cliffs, debt cliffs, and austerity cliffs on the country.  Now in control of Washington, Republicans look poised to set up an Obamacare cliff.  This might be the most reckless act of GOP gamesmanship yet.

When it comes to Obamacare, the GOP is the dog that caught the car.  Republicans have railed against the law for years, voting to repeal it 60 times and shutting down the government in protest.  But now that they are in power, Republicans are finding themselves utterly ill equipped to take action against the law.  That’s because they still haven’t yet readied a nuts-and-bolts health reform plan over the last six years.  Even though “repeal and replace” has long been their rallying cry, conservatives have spent precious little time forging a unified strategy for the latter part.

Aside from policy considerations, “repeal” also has a simpler legislative path than does “replace.”  The GOP can repeal most of the law through a reconciliation bill on a bare-majority vote, meaning without Democratic cooperation.  To affirmatively pass a replacement law, however, Republicans will need Democratic votes, unless they kill the filibuster (which some key Republican senators are reluctant to do).

This combination of policy uncertainty and political expediency is pushing the GOP toward a strategy of quickly repealing the law on a time delay.  Without a readily available replacement, Republicans will try to repeal the law while postponing its actual demise until perhaps January 2019, after the 2018 midterm elections.  This would ostensibly give Congress two years to devise a replacement for the law, extending Obamacare a two-year fuse until it explodes.

GOP health policy expert James Capretta objects to this strategy on the grounds that Congress will wind up perpetually extending Obamacare’s two-year lifeline.  “If . . . the GOP sticks with a repeal-only bill,” Capretta argues, “there is a high probability that they will never get around to agreeing on a workable replacement plan. At which point the odds would then favor retention of the ACA, or something close to it, as the only viable way forward.”

Capretta points out that legislative momentum will only wane after 2017 and into 2018.  The likelihood of an Obamacare replacement doesn’t increase over time, but dwindles by the day.

Keeping Obamacare on the books may be the conservative nightmare scenario.  But the other consequences of the GOP’s reckless repeal-and-delay course are far more dire.  For one thing, the mere contemplation of repeal, let alone actually passing a repeal bill, may be enough to create an insurer stampede out of the law’s marketplaces.  Insurers must decide whether to offer plans for 2018 in the marketplaces before May 2017, just three months into the new Congress.  Many will be unlikely to participate in a program that is in the midst of being slowly killed off.  This is particularly true given the already fragile state of the exchanges, which are in need of constructive reform, including previous wounds inflicted by the GOP to strip the law’s protections for participating insurers.  If insurers flee a perceived sinking ship, the law will cease to function whether it’s officially repealed or not.

If the GOP forges ahead with repeal-and-delay and triggers an insurer exodus in the process, there very well may not be any can to kick down the road again come January 2019.  The law could become zombie health reform with impotent, ghost-town marketplaces.  There would be nothing left for Congress to extend.

So the GOP likely cannot reap the political benefits of repeal while putting off the tangible costs for two years.  And those costs would be very real.  The private insurance markets in all fifty states could seize up, making it functionally impossible for the millions of people who currently rely on Obamacare’s exchanges today to obtain coverage.  The historic gains we’ve made in expanding insurance would quickly reverse.  Repeal-and-delay would take a massive human toll.

So if the exchanges are mostly bled dry by Republicans before January 2019, what then?  Once the GOP lights this fuse, the rapid deterioration on insurance markets would probably place immense pressure on Democrats to cooperate with right-leaning reform efforts.  And if the 2018 midterm elections become a backlash against Trump and restore Democrats to power in Congress, then Democrats would be left to clean up the healthcare mess that the GOP is about to create.

The GOP’s repeal-and-delay strategy is ostensibly meant to buy Republicans time to devise a substitute to center-left health reform.  But it’s hard to see what Republicans will be able to dream up in two years that they couldn’t in six.

Setting up an Obamacare cliff once again triggers a high-stakes game of chicken.  But unlike previous congressional chicken matches, blinking at the last hour might not spare the harm this time.  Rather, because Obamacare relies on private health insurers to expand coverage (i.e., because Obamacare is a centrist attempt at universal healthcare), the harm of repeal may be realized well before Congress even has a chance to flirt with plunging over any self-concocted cliff.

So Republicans pushing repeal and Democrats opposing it need to understand that “repeal and delay” is functionally no different than straight-up repeal .  Delay does not postpone the fight for another day.  When that day comes, it will already be too late — the law’s foundations will already be drastically weakened, perhaps entirely moribund.

Republicans are trying to set up yet another cliff to force congressional action.  But the cliff is much, much closer than it might appear.  The question is who truly realizes it.

The missing Democratic narrative

In the fall of 2015, the economists Anne Case and Angus Deaton discovered something disturbing: the mortality rate for middle-aged white Americans—and only them—had sharply increased over the previous 15 years.  Most of this increase was from an alarming explosion in the number of suicides and “poisonings” from drug overdoses among this population.

Meanwhile, Donald Trump was on his warpath toward the Republican nomination.  And he was winning heavily in the distressed communities that Case and Deaton studied, cleaning up in the counties with the highest middle-aged white mortality rates.  These places were littered with the skeletons of abandoned factories, but were ghost towns when it came to jobs and degrees.  The misery and desperation was ripe for Trumpism.

Case and Deaton had landed upon the most troubling and violent indication of what is a larger existential unease within much of the country.  Deaton speculated that these Americans had “lost the narrative of their lives — meaning something like a loss of hope, a loss of expectations of progress.”

Donald Trump became president-elect last week in part because he filled in that narrative with what had gone wrong.  For “the forgotten men and women of our country,” as he called them, who feel that they have been forcibly displaced from the American economy and society, Trump provided a story grounded in resentment and named culprits.  They’d been shafted by Washington elites cutting bad trade deals that ship jobs overseas, he told them.  They’d been cast aside for immigrants pouring over the border with drugs and crime, he warned.

This narrative aligned with what many people want to believe and what they see around them.  They see shuttered manufacturing sites that once employed thousands.  They see superstores where nothing is made in America or by Americans.  They see neighbors and family members consumed by opioids.  They see the lives of minorities and immigrants who “cut in line” ascending, while theirs languish.

Liberals can and should object to the honesty and intolerance embedded in Trump’s tale.  Yes, we’ve done too little to cushion workers from the dislocations of trade.  But neither Trump nor any other politician is bringing wide-scale manufacturing employment.  And while immigrants are an easy scapegoat, they have little impact on the wages or employment of native-born Americans.

Trump’s story is a manipulative con.  But it’s the only one that Americans were offered in this election.  Hillary Clinton did little to offer a competing narrative that spoke to the continuing anxieties and inequalities of millions of Americans.  For all the progressive policy ideas Clinton developed, she never synthesized them beyond the contentless message “Stronger Together.”  The reach of her campaign left her unable to develop a message with any specificity.  Hoping to rout Trump by a historic margin, she crafted a tent so big that it collapsed in on itself.

This has revealed a fundamental problem for Democrats.  For six years, the party has gotten walloped in virtually every national and state election  where Barack Obama’s name has not been on the ballot.  As he exits the national stage, the Democrats can no longer depend on his coattails.  They need to win by standing for something that connects with voters.

There is one clear narrative percolating within the Democratic Party.  And it’s coming from the party’s left flank.  Elizabeth Warren and Bernie Sanders are interpreting the election results as reflecting widespread frustration with an economy rigged by and for the wealthy and powerful.  In their version, there has been a thirty-five year project of deliberate government policy and tax cuts that redistributed money to the most well-off.  This hollowed out the programs, investments, and institutions that once upon a time created a thriving and secure American middle class.  The wealthy reached the highest rung of the social ladder and then pulled the ladder up behind them.

This too makes for a compelling story.  And there’s a good deal of truth to it.  The growth in inequality in the United States closely corresponds with the onset of the Reagan revolution and the shift toward supply-side economics.  At the same time Reagan was slashing taxes on the rich, deregulating industry, and implementing free market reforms in the early 1980s, inequality began rising.  Economists on the left argue that these kinds of unbalanced tax cuts and reductions in public programs increase inequality.  As inequality boomed, incomes for the middle stagnated.  And for those becoming displaced and rendered obsolete by the economy, the bottom fell out.

This would be an exceptionally opportune time for liberals to start loudly making this case to the public.  With unified conservative control of Washington, Republican leaders are gearing up to pass a round of massive tax cuts tilted heavily toward the wealthy.  Both Trump and Paul Ryan have proposed trillions of dollars in tax cuts.  They’ll just need to sort out whether half of all the benefits will go to the top 1 percent (Trump’s plan) or if 99.6 percent will (Ryan’s).

These tax cuts will inevitably rob from important social spending on education, healthcare, food assistance, and poverty programs.  They will suck more money out of the very communities that need it the most.  This will exacerbate inequality, not reverse it.

By offering up this kind of narrative, Democrats can accomplish two things in one fell swoop.  First, they can counter the fraudulent story that Trump has successfully sold so far.  Second, they can show that Trump never had the back of working people—that he’s looking out for his interests and those of his class by passing yet another typical Republican supply-side tax cut.

To build a party that isn’t dependent on one man, the Democrats need to contextualize and offer solutions for the discontent afflicting many Americans.  Trump did that, even if his pitch was a working-class sham.  To mount an effective opposition and win back power, Democrats need to offer voters a narrative of their own.

The awe-inspiring and dispiriting United States of America

It’s a whole new world, and like most everyone else, I didn’t see it coming.  Coming to grips with what Trump’s America looks like and means will take a long, long time.  But my immediate, still-distraught reaction is up at Medium.  The concluding thoughts:

The last eight years have seen a remarkable amount of social progress. Marriage equality became a reality. The century-long quest for health reform came to pass, protecting millions from devastation by illness. We fought off economic catastrophe and have made steady gains ever since. We created millions of jobs and built a thriving renewable energy industry for the twenty-first century from the ground up. We made serious inroads to curtail environmental harm and combat climate change. We took steps to corral a financial sector that helped land the entire economy in peril.

Trump’s election jeopardizes many of these gains. But it does not erase the fact that we are a society capable of producing the achievements of the Obama years.

We have seen figures like Trump before in our politics — people like George Wallace, Strom Thurmond, Jesse Helms, and other poisonous demagogues. Never before have we allowed one to come close to our highest office, let alone win it. That is unprecedented in our history.

But so was electing a black president. This may seem confounding — after all, how could the country that twice elected Barack Obama elect Donald Trump?! But the United States is a baffling and frustrating place — at once both awe-inspiring and deeply dispiriting. Admirable progress over the ills of our history often gives way to reactionary backlash and retrenchment.

We have a long and storied history of taking one giant leap forward, only to follow it up with a gut-wrenching step back. Lincoln’s freeing of the slaves in 1863 and a decade of Southern Reconstruction gave way to nearly a century of Jim Crow, lynching, segregation, and violent white supremacy. The outlawing of segregated schools in 1954 triggered massive resistance to black and white children learning together. The Civil Rights revolution of the 1960s fed Richard Nixon’s silent majority and the ensuing limitations on civil and equal rights. That Barack Obama will now turn the White House over to the birther Donald Trump is tragically in keeping with the rhythms of American history.

Yet we can change these rhythms. Obama likes to quote Martin Luther King’s statement that the arc of the moral universe is long, but it bends toward justice. Tuesday’s jarring electoral result is a reminder that the moral universe bends only from the dogged persistence and faithful agitation of those refusing to give up the fight. Progress is not guaranteed, and advancement is not simply the natural course. Left alone, the moral universe quickly reverts back toward a darker past. When we ease up, it eases down.

But by fighting on, we hasten the day when our country’s government once again stands for hope, progress, and decency. So don’t look to Canada. Don’t give up on America, and don’t drop out of politics. Despair today. Then rejoin the fight.