In this photo taken on, Tuesday, April 4, 2017, the Capitol in seen from the Supreme Court Building in Washington. (AP Photo | J. Scott Applewhite)

In this photo taken on, Tuesday, April 4, 2017, the Capitol in seen from the Supreme Court Building in Washington. (AP Photo | J. Scott Applewhite)

Opinion: The identity politics of Obamacare

It’s been more than eight years since Democrats in Congress passed the Patient Protection and Affordable Care Act, or Obamacare, as the law Republicans loved to hate soon became known. “Repeal and Replace” is the sequel. It’s a story less about how to govern America than a defining distinction between those who call themselves real Republicans and Republicans in name only — or RINOs.

Neither repeal nor replace were ever seriously considered. If they had been, congressional Republicans would have drafted serious replacement legislation long before 2017.

What happened instead is, once they had the power to do something, the establishment wing conceded provisions such as the “prohibition of preexisting condition exclusions or other discrimination based on health status,” and the rule which allowed children to stay on their parent’s plan until the age of 26, were either sound public policy or so popular that eliminating them would be political suicide.

So instead of a new law, they proposed amendments to Obamacare that kept those while selectively eliminating others. They especially targeted the individual mandate to purchase health insurance.

Two attempts to amend the law were made. The first was never voted on because it either repealed too much or didn’t go far enough. The so-called “skinny-repeal” failed in dramatic fashion a month later when Sen. John McCain broke party ranks with Sens. Lisa Murkowski and Susan Collins.

A piecemeal approach to undoing Obamacare followed. Under the guise of tax reform, Congress did away with the individual mandate. It’ll be formerly euthanized on January 1, 2019. And the Trump administration proposed a rule allowing Americans the option of buying inexpensive, short term insurance policies which exclude some of the benefits required by Obamacare.

Murkowski supported both. But she isn’t prepared to toss out the rules protecting patients from discrimination due to preexisting conditions. That, along with her recent vote against the confirmation of Brett Kavanaugh to the Supreme Court, proves to real Republicans that she’s just a RINO.

Real Republicans still want to put the entire law, not just the individual mandate, into the dumpster. And because they know Congress won’t do it, party officials from 20 states are asking the courts to rule Obamacare unconstitutional.

Their argument goes like this. The individual mandate was a core provision that the rest of Obamacare relies on. And the U.S. Supreme Court already acknowledges the individual mandate without a tax penalty is unconstitutional. Therefore, when Congress eliminated the mandate in the tax bill, it means the Obamacare itself is no longer constitutional.

In June, Attorney General Jeff Sessions notified Congress that his department doesn’t agree with the plaintiffs that all provisions of the Obamacare were invalidated by the tax reform. And a few weeks ago, his attorneys in the case argued against nationwide injunction of the whole law because it “could throw the health care markets into chaos.”

But as directed by Sessions, they aren’t defending the constitutionality of the section containing the mandate. Or the prohibition against discrimination on the basis of preexisting conditions. That contradicts what President Trump wrote last week in USA Today about keeping his campaign promise to protect coverage for patients with preexisting conditions.

What’s missing in all these actions is a comprehensive solution to the health care problems that have plagued Americans for decades. It’s simply never been part of the Republican platform during the years in which they had control of Congress.

But in the 1990s they opposed such legislation on principle. They believed every aspect of the economy, including access to quality, affordable health care and health insurance, should be regulated by the free market and the states, not the federal government.

Now, under the party of Trump, that political canon has been given the boot. That’s why the party of free trade can’t offer more than mild criticism of Trump’s unilateral tariffs. That must be very frustrating to principled defenders of the Constitution because Article 1, Section 8 delegates to Congress the sole authority “to regulate commerce with foreign nations”

On trade, standing for principle matters less than loyalty to the party and the party boss. And so it goes with the repeal and replace story on Obamacare. A true Republican must hate it so much that it must be repealed. Anything less is heresy.


• Rich Moniak is a Juneau resident and retired civil engineer with more than 25 years of experience working in the public sector. He contributes a weekly “My Turn” to the Juneau Empire. My Turns and Letters to the Editor represent the view of the author, not the view of the Juneau Empire.


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