openpolitics.com

The Affordable Care Act has widely been held aloft as one of the leading drivers of the deepening polarization of American political life — it has been bitterly fought over for years and has loomed as a great embodiment of all that ideologically divides the two parties. Yet in a strange twist, the GOP debate over repeal has actually revealed that there is a surprising amount of hidden consensus on health care.

.. nutshell, what the debate has really shown is that the passage and implementation of the ACA has given rise to a latent majority in Congress — or at least one in the Senate — that has more or less made peace with the ACA’s spending and regulatory architecture and its fundamental ideological goals

.. GOP Sen. Jerry Moran of Kansas that neatly illustrates the point. Moran is a GOP loyalist who previously headed the GOP Senate campaign arm and sits firmly in the mainstream of today’s GOP. Yet even he is having trouble supporting the GOP bill.

.. He did not describe the task facing Republicans as repeal; it was “repair, replace, whatever language people are using.”

Pressed by activists and voters, Moran said that he did not want to cut back Medicaid. “I have concern about people with disabilities, the frail and elderly,” Moran said. “I also know that if we want health care in rural places and across Kansas, Medicare and Medicaid need to compensate for the services they provide.”

After the town hall meeting, Moran told reporters the version of the GOP’s bill that he opposed put too much of Medicaid at risk.

.. He is suggesting that, while able-bodied adults might allegedly be scamming their way onto the Medicaid expansion, this issue should not be taken to justify the deeper cuts to Medicaid. And this, as Weigel notes, unfolded in one of “the reddest parts of a deep red state.”

.. The bottom line is that Republicans who currently oppose the Senate bill object to it because it would roll back federal spending in a way that would hurt millions and millions of people. This includes Moran and moderates such as Dean Heller of Nevada, Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Rob Portman of Ohio, all of whom have made variations of this argument. Some, such as Collins and Sen. Bob Corker of Tennessee, have even objected on the grounds that this would finance a massive tax cut for the wealthy, and that this is indefensible.

.. All of this is dramatically at odds with the ludicrous spin coming from GOP leaders such as John Cornyn of Texas and House Speaker Paul D. Ryan of Wisconsin, who argue that the millions left uncovered under the GOP bill will be choosing that plight, because they will have been liberated from the hated ACA mandate.

.. To summarize, Republicans are arguing both that

1.  millions won’t actually be hurt by these Medicaid cuts, either because they aren’t really cuts, or because everyone will have “access” to health care later; and that
2. if many millions of people go without coverage who would otherwise have been covered, they did so by choice.

it is of course possible to make a principled argument against the mandate, Republicans are doing something else entirely: They are hiding behind their arguments against the mandate to evade acknowledging the true human toll their proposed Medicaid cuts would inflict.

What this really means is that they are basically fine with rolling back the ACA’s massive coverage expansion to facilitate a massive tax cut for the rich, but just won’t say so out loud.

But all indications are that moderate Republican senators — and even senators such as Moran — are not fine with this outcome.

Now, these objecting senators may still end up supporting a revised GOP bill in the end, due to party pressures and other factors. But if they do, they will only justify it by pretending that a few additional last-minute dollars (in relative terms) added to the bill would put a meaningful dent in the enormous coverage loss

.. This would mean their current objections were insincere.