A few years ago, I posted to this blog a piece of pure speculation. It was about the failure of Senate Republicans to repeal the Affordable Care Act (ACA) in 2017. Based on no evidence whatsoever, I posited that the Senate vote had failed because Mitch McConnell had rigged it to fail.
My reasoning was that even though Republicans had been screaming for the repeal of “Obamacare” since its inception, repeal was the last thing they actually wanted.
Sure, they’ve had a jolly old time trashing the ACA over the years. Trump lost no opportunity to call it “a total disaster” in his 2016 campaign.
But the prospect of coming up with a workable replacement for a healthcare system so big and complex was something the GOP had neither the intelligence nor the policy chops to take seriously. Republicans don’t go into government to govern.
Still, even they could see that the ACA had grown remarkably popular over the years — people with health insurance tend to be protective of it — and it was becoming a sort of third rail with voters, like Medicare and Social Security. They couldn’t just kill it without replacing it with something, anything.
And it wasn’t just that millions of people now had health insurance. It’s that they now had new options for using that insurance, thanks mostly to the massive government investment in medical infrastructure that the ACA made possible.
This aspect of Obamacare has been woefully under-appreciated. People don’t get that the ACA — as administered by the Dept. of Health and Human Services — is directly responsible for the vast proliferation of hospitals, urgent care centers, specialty clinics, and all manner of health and medical facilities that are now almost ubiquitous in our cities and towns.
Ordinary people have still not made the connection between all those “human services” and the government that makes them happen. Nor do they grasp how the withdrawal of federal funding for those services would cost millions of jobs, and ultimately millions of lives. Both the jobs and the lives lost would fall disproportionately on Trump voters.
Even back in 2017, this was obvious, even to McConnell, whose home state of Kentucky was by then a big ACA success story. He also understood that the dimwits in his party would never come up with a reasonable alternative to ACA, and that his constituents would not take kindly to dumping it.
In my article, I speculated that, just perhaps, McConnell had found a good Machiavellian solution to his dilemma. Just perhaps he gave Susan Collins and Lisa Murkowski permission — tacit or otherwise — to vote against the repeal, which history records they did. Leaving McConnell still one vote short of killing the very bill he was publicly trying to pass.
So, just perhaps, he gave a dying John McCain a chance to go out in a blaze of glory. McCain famously cast the deciding thumbs down, and the repeal failed.
We’ll never know if it went down that way, but I’ve always found it extremely odd that the GOP came so close to one of their most cherished goals, only to have their “victory” snatched away so dramatically. It was a gilt-edged opportunity to kill Obamacare, and to this day it seems absurd that they didn’t get it done. Which makes me think they didn't want to.
Since then, Republican office-holders have seemed to let the matter drop, content to let Democrats expand and improve the ACA, while they could keep bashing it as a nanny-state giveaway.
Even Trump seemed to lose interest. He floated it as an issue early in this election — we all remember his “concepts of a plan” —but I think even he saw it wouldn’t get the same traction it did in 2016.
Unfortunately, the cranks at Project 2025 couldn’t let it go. Their manifesto makes perfectly clear that Obamacare looms as a major roadblock in their forced march back to the thirteenth century.
So now, with Trump taking office yet again, it would seem that the ACA is in trouble yet again.
But I’m not so sure. Yes, there are no doubt plenty of billionaire donors who would love to repeal it once and for all, consequences be damned. But even in red states, people should quickly understand what they have to lose. Even in red states, state and local officeholders won’t relish taking health coverage away from their constituents. And even in the Senate and House, there are surely a few Republicans who will have no appetite for revisiting such a fraught issue.
With this in mind, it’s perhaps instructive — in an opaque way — that Trump has now said, on several occasions that “I saved Obamacare.”
He first uttered this fact-free claim during the campaign, and said it again on Meet the Press last week. I’m thinking we might be hearing more of it going forward.
Please understand that I do not credit Trump with any mental facility at all, and I’m skeptical whenever his handlers let him out of his cage. But whenever Trump starts repeating the same nonsense over and over, I have to wonder what’s going on among the cobwebs in that brain.
Repetition is, after all, what he does best. He floats a lie, then he repeats it, ad nauseam, until it morphs into the truth. For him, this is as natural as breathing.
But where is he going with this particular lie? Since his followers are the only ones who believe a word he says, does he actually want them to believe that he saved Obamacare, whatever that means? What’s in it for him?
It might mean nothing, but it might also mean he’s walking back his long-term promise to kill the ACA. If he “saved” it, that implies there’s something worth saving.
It also gives him an easy way to “replace” it. Just as he did with NAFTA in his first term, he can make a few cosmetic tweaks, leave the rest of it as it is, and rebrand it as a product of his own brilliance. Voila! Trumpcare. Why replace when you can co-opt?
Yes, this is through-the-looking-glass stuff, and we’d be crazy to take any of it at face value. But it’s certainly plausible. And it’s certainly consistent with Trump’s epic inconsistency.
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