The ACA and the election

Great Debates
1

OK, I don’t think this is really an Elections topic, and I will try and not rant, to keep it out of the BBQ Pit. I think this is really a debate. That said, if the mods feel it should be moved, it’s fine by me (just not to the Marketplace, please, since I can’t post there, I think :)).

Anyway, for the purposes of this thread, let’s assume that Trump wins the election and the Republicans keep the Senate (and the House). However, they don’t have a 60 vote majority in the Senate and they keep the filibuster alive.

In that case, I’m going to assume that the House votes for the 60-somethingth time to repeal the ACA. I’m further going to assume that the Senate Republicans would also vote to repeal. What should the Democrats do in that case?

Well, to keep Obama’s legacy alive, you might say, of course they should block the vote by any means possible. I’m not sure I agree with that (and I’m a supporter of the ACA, even in its flawed state).

First, if this country votes for Trump and the Senate Republicans, it’s a clear sign to me that the country, by and large, does not want the ACA to remain in effect. Second, the ACA really is flawed. There are many ways to fix that (fix the medicaid hole, allow a public option, tighten up the mandate), but with Republicans in charge of the legislative and executive branches (and, I guess the judicial branch at that point), there won’t be any fixes applied, and the real flaws in the legislation may actually cause it to start failing. More insurance companies may drop out of the exchanges, for example, leading to less competition and higher prices, causing more relatively health people to drop the insurance and just pay the relatively weak tax fee for the mandate.

Maybe the Democrats in the Senate should just insist that the states are given some time to set up their own systems, should they choose to, before the law lapses. Small states who may want to continue to provide some sort of universal healthcare could join up with their larger neighbors to create a better insurance marketplace. Massachusetts was able to go it alone, maybe Rhode Island could join their system. Delaware, NJ, and Maryland could create a regional marketplace, and so on. The Dakotas, should they want to provide this, could join with, say, Minnesota. States that want to abandon the system could, after some grace period, go ahead and do so.

Third, as a pointy-headed Northeastern liberal elitist, I really am getting a little tired of having to fight for the people in the more needy states who seem to vote against their own interests. If Mississippi wants to continue to vote for tax-cutting Republicans who want to cut social programs, at some point I say, OK, we’ll stop sending our money your way. Blue states, by and large, are net payers into the federal coffers (with some exceptions) and red states are net receivers (with some exceptions). I don’t know which states were helped more by the ACA (and it was a little skewed anyway, since some states actively worked against it), but those that saw great benefits and worked towards implementation may be able to keep it going on their own.

It’s a little like abortion laws (and, I really hope this doesn’t derail the thread) – I’m in a position where if it Roe were overturned, my state would likely keep it legal, and even if it didn’t, I could pay to get my daughters out of trouble by travelling someplace were it remained legal. At some point I just want to say, go ahead and ban it. I’m tired of the fight and I can take care of myself.

(TLDR) Anyway, the debate is:

If Republicans win the presidency and keep the Senate and vote to repeal the ACA, should the Democrats do whatever they can to keep it in place. I think they should let it lapse, after some grace period for the states to set up their own system.

2

This doesn’t follow, although that’s probably what the Republicans would argue. Voters could elect Trump and the GOP while having favorable views of the ACA. Better evidence would be opinion polls.

Most liberals would be appalled to let the ACA die, but as the race continues I’ve seen more accelerationist logic about how Trump could result in a huge backlash. The idea being that going back to the old system would be a disaster and maybe a way to get UHC instead of being tied to the ACA for another generation or two. Dreams are one way of coping, I guess.

3

I think the polls show that voters don’t like “Obamacare”, but they like many of the provisions of the ACA. I’m not sure where that leaves the question. And, to be clear, I’m not arguing that the Senate Democrats should let it die because it will cause a backlash that will lead to single-payer healthcare or something along those lines. I’m arguing that they should let it die because the voters have spoken.

The ACA itself is a huge compromise because the Democrats couldn’t even get their whole party on board – that is, not even the Democratic senators were sure they liked it. The had to make compromises to get Joe Lieberman and, I think, Ben Nelson to go along with it. So, from the get-go, it was only barely popular enough to pass.

As many have said, elections have consequences. Many younger voters don’t vote or are planning on voting third party. How many of them are still on their parent’s insurance, since the ACA raised the cut off age to 26? Many low income people vote for politicians who promise to cut taxes and social programs. How many of them are missing the benefits because their state decided not to expand Medicaid?

If I were a Democratic Senator, at some point, I would say, enough. You don’t want the ACA? Fine, let’s let the states decide how to take care of their own.

4

What happens if you have a state that goes from Democratic to Republican to Democratic to Republican, etc, over time? If the ACA kept getting started, then stopped, then started, then stopped again for a particular state, it would cause chaos for that state.

Which is more pointing out a problem than proposing a solution… the federal government also switches parties from time to time.

5

I don’t think the states change that drastically that quickly. For example, Massachusetts has switched from a Democratic governor to a Republican governor and they still kept their system in place. In fact, the system was started under a Republican governor.

Anyway, back to the debate, should the Democrats allow the ACA to be overturned if they find themselves out of the presidency and a minority in the senate?

6

There’d be a 4-year filibuster.

7

Thank you for your contribution, but I’m not asking what they will or won’t do, I’m asking what they should do. As a commie pinko East Coast liberal, I’m saying they should let it go. At some point, the people have spoken.

The Republican party has been running on an anti-ACA platform since it came out. If voters want to put them back into office along with Trump, then I think it’s time for the ACA to go.

8

Sorry, my misunderstanding.

In that case, Democrats should let ACA be replaced by single-payer with strict tax/cost ceilings and a meaningful deductible. ACA was never the panacea it’s often hailed to be, nor the horror it’s painted to be.

9

The Republicans would change the Senate’s rules to discontinue the Filibuster…this one time. Every time the Democrats Filibustered, there would be a one-time ad hoc rule change to forbid it.

Then, four years later, when the Democrats do the same thing, they will complain bitterly.

Ultimately, it’s the death penalty for the Filibuster, and America becomes just slightly more “Parliamentarian” in our legislature. Look for more protests such as walk-outs and folk-song takeovers (both sides.)

10

I’m not sure I follow. Your theory is that, if Trump wins and the Republicans take over the Senate, then those Republicans will propose replacing the ACA with a single-payer system?

I agree – if that’s what the GOP Senate proposes, and House agrees to, the Democrats should help get it passed. Seems unlikely, though.

11

Well, yeah, that’s doubtful.

But repealing ACA should depend entirely on what the replacement is. If better than ACA, yes, if not, no.

12

I’d agree that they should let it go. The Republicans have made opposition to the ACA a major part of their political platform. If they win, that’s a reasonable metric. Elections have consequences.

Although, this particular moderate liberal doesn’t really care for the ACA, so I’d be kinda happy to see it go away (I’d like to see it replaced with a sensible health care policy with many fewer moving parts, but I’d like a pony, too).

13

Agreed. I’m a bit disappointed that this thread hasn’t really gone anywhere. Maybe with 538 now predicting a Republican Senate and a coin toss for the presidency, this will become a more interesting topic.

My view is that the Democratic Senators should vote against repeal but not stop it by other means (e.g., a filibuster). If there is anyone who thinks they should stop it by filibuster or other means, I guess my follow up would be:

How far should they go? Should they stop cabinet approvals? Judicial approvals? Threaten to shut down the government?

My answer to all of those would obviously be no. Further, I really wouldn’t want the Democrats in the Senate to go down an obstructionist path. It seems like every time the power shifts, the next minority ratchets things up a bit (I’m not saying both sides are equal). Playing with government shutdown accomplished nothing positive, but did get our credit ratings cut.

14

Nonsense. The country’s polls indicate that Clinton is more trusted on healthcare issues then Trump is even as he leads on other issues such as terrorism and the economy. Thus a Trump victory and a renewed GOP majority in Congress could just very well indicated voters chose them on the basis of their stances on trade, immigration, and foreign policy. By this reasoning, Democrats shouldn’t do everything it can to block say mass deportations since voting Republicans implies the country favours it.

In that case, the Democrats should be fighting to point out the actual problems being caused by Republican inaction not effeminately submit in silence to GOP repeal, thus implicitly accepting the right-wing narrative that the entire idea of the ACA was a boondoggle. Plus even if the exchanges failed, provisions such as Medicaid expansion, prohibiting preexisting conditions as a pretext to deny health insurance, and allowing young adults to stay on their parents’ insurance are real, significant improvements and ought to be preserved.

The goal of the Affordable Care Act was to guarantee health insurance to all Americans-your plan simply goes back to the 2010 status quo. Plus as we’ve seen with Vermont, individual states or even groups of states have much less power to create frameworks and/or negotiate for lower health insurance prices compared with the national government as a whole.

I think the phrase is almost always stupid and certainly overused, but “check your privilege” applies here. The project of American liberalism from the days of the New Deal and perhaps even from the Civil War onwards has been to guarantee universal social insurance, basic civil rights, and a decent standard of living to all Americans by virtue of being American. Call me a bleeding heart if you will, but I don’t think voting Republican for whatever reason means you should find yourself dying from late-stage cancer because you didn’t have health insurance to afford a routine checkup or going bankrupt after being hospitalized for an injury. I consider the fact that the United States is the only developed country in the world without universal health insurance a national scandal and disgrace-an intolerable stain upon the Republic which any beating patriot heart ought to abhor since true patriotism means love for not just the abstract concept of America or the icon of the Flag but the men and women who make up the national community.

This is even ignoring the fact that all “Red” states have significant numbers of Democratic voters (the blacks of Mississippi River valley vote 95% for one party and it isn’t the Republicans), who are disproportionate low-income and minority and thus stand the most to lose from repeal of ACA and similar legislation. If the state government cannot protect the unprivileged, it is the duty of the federal government to do so-that is a fundamental tenet of American liberalism. By your logic, LBJ should never have fought for federal civil rights legislation as long as the Northern states had racial equality in their own domains and since the Democrats stood to alienate the Southern vote. I won’t even get in to your embrace of Republican “Makers and Takers” rhetoric.

Since I’m opposed to abortion, I have no objection to your hypothetical but for pro-choicers, this reasoning again is troubling since it’s literally “screw yours, I have mine” which is the logic of the hedonist libertarian not a liberal. Perhaps your reasoning shows the necessity of an element of American nationalism in any consistent and effective liberal philosophy.

We should also endorse massive tax cuts for the wealthy, mass deportations, and war with Iran clearly since “elections have consequences”.

If you oppose even a milquetoast bill like the ACA (unless you oppose it in favour of something more expansive), you aren’t a liberal in any meaningful sense of the word.

Considering the Republicans have started the game why should not the Democrats retaliate in kind? To not do so is the reasoning of the weak and the appeaser, with which the principle of nuclear retaliation (among other things) would fail utterly. The American people certainly won’t reward the Democratic Party for bending over-while I generally despise the principles of PUAs, the principle of “Nice guys finish last” applies especially to politics considering conservatives who hated the ACA will vote for the real thing while liberals who not just supported but laboured and sweated for the ACA will have been stabbed in the back-“Et tu, DNC”

15

The idea that they wouldn’t use a filibuster is silly. It’s automatic. The only way a filibuster doesn’t get used is if the procedural filibuster gets abolished, which would only hurt Republicans in the future (or they would have already done it).

It de facto takes 60 votes to pass anything in the Senate. What matters is if they can get some Democrats on board for the repeal.

16

To conclude that an American public which elects Trump is an America that doesn’t want ACA is like concluding that a deer transfixed by a car’s headlights is a deer that wants to die.

Rather than repealing ACA outright, the GOP Congress may propose major amendments, and the Democrats will want to apply filibuster threats selectively to mitigate the damage. If the Democrats filibuster all amendments, they may end up blamed for the damage — I think a President (especially one prone to authoritarianism) who didn’t want ACA in its present form would be able to throw sand in its works by his appointments and executive actions even without Congress repealing it.

The idea that the GOP controls all three branches of the Federal government as well as most of the states would be a frightening thought even were the President a relatively sober right-winger like Kasich or Pence. Under a President Trump, the dangers are so great that ACA should be the least of our worries.

17

You wrote a long and thoughtful response, and you deserve a more thought out answer than I am about to provide. I agree with many of your points, but I’m just tired of all the fighting.

On this specific point above, I think the ACA was a great, but flawed, step forward. However, in my opinion, there is no other issue that the Republicans have pushed more than this. They haven’t voted to deport immigrants 57 times, they haven’t voted repeal of Obama’s tax hikes 57 times, and so on and so on. This is their signature issue and if they end up being the Senate majority and have the presidency (who then appoints Scalia version 2.0 to the S.C.), I think this is one issue that the Dems should give up on. It has been a large distraction for the president and the courts. If Mass. can do this on their own, then groups of states who want to can implement it as well. The ACA provided a blue print (as Mass. did), and willing states can follow suit.

Regarding following the Republicans down the path of total obstruction, I really couldn’t disagree more. Republicans run partially on a government-can-do-no-right platform. The Dems have to prove them wrong.

18

We’re already at that stage, and there are plenty of threads about our other worries. This one is about the ACA.

If the new president throws sand in the works and causes it to basically fail, that will bolster arguments that the US is unique and just can’t do universal healthcare right. If it just gets overturned, it wouldn’t have that effect.

19

I’m sure that my luke-warm feelings for the ACA are coloring my response a bit here, but no, I’m not suggesting they “endorse” any of those things. Simply that at some point you have to let people who won elections make the policy. Even if you disagree with that policy.

I mean, if we had this really great health care policy and the Republicans wanted to dismantle it, I might feel more strongly. But even supporters of the ACA admit that it’s kind of an awkward half-measure with lots of complicated bits that don’t quite work right because they had to go with a partially-baked bill when the Republicans gained another seat.

Maybe, put it another way. Of those things you mentioned, I feel like keeping the ACA is the least important. So, should the Democrats filibuster and procedurally block all of them? Or are only some of them important enough to do so. Should they block every possible thing the Republicans want to do? Where do you draw the line?

20

:confused: Repealing ACA and replacing it with nothing would be absurd. After the cost and inconvenience of massive adjustments for ACA, to then undergo the massive cost and inconvenience of undoing it would be so farcically stupid even many GOP Congresscritters would realize it.

Instead, expect a GOP Administration to propose amendments to ACA. Some of the amendments will be ones the Democrats wanted before but couldn’t pass while the GOP “wanted Obama to fail.” But the GOP will be focused on corporate profits and screwing the little guy wherever they can, just because they can.

The extent of GOP control today already makes me sad. If Trump actually wins, I may just stop reading news altogether, stop reading SDMB, and find new hobbies.