Obamacare Collaborators?
Resist Obamacare from without, or undermine it from within?


Daniel Foster

After it became clear on Wednesday they did not have the support to pass a bill that would repurpose (especially) wasteful Obamacare funding to bolster the “high-risk pools” for people with preexisting conditions created by that law, House Republican leaders cancelled a scheduled vote. They promised to revisit the legislation when the body comes back from recess in May.

H.R. 1549, titled, with the requisite vacuity, the “Helping Sick Americans Now Act,” pitted the GOP leadership and its allies against an odd couple of conservative Republicans, who will settle for nothing less than full repeal, and the Democratic caucus, who won’t stand for the GOP’s meddling with its handiwork. It also highlighted the dilemma that has continually dogged the Republicans in Congress and in the states who have formed a kind of Obamacare Underground: Is open resistance the only way to stop Obamacare? Or is this kind of subversive collaborationism a useful tack?

First things first: What’s good about H.R. 1549, which critics on the right have dismissed as so much deckchair rearranging? Well, for one, the source of the money is a $10 billion Obamacare slush pot called the “Prevention and Public Health Fund” that Kathleen Sebelius and her Department of Health and Human Services have tapped to fund local bike-path, community-gardening, and pet-neutering projects; to lobby for soda taxes; and to pay for $300 million in TV-ad spots designed to resign the American people to their fates under Obamacare. Vaguely purposed pools of cash like this are a straight-line extension of the “walking-around money” campaign workers use for “expenses” incurred canvassing for votes, and any measure that shrinks the supply of grease available to lubricate palms in our patronage state is worth supporting in itself.

Second, and relatedly, reclaiming moneys from the discretion of Kathleen Sebelius — who already wields untold billions — and reasserting Congress’s power to budget and appropriate is good for the separation of powers. It is also good for Republicans, since the Congress that deputized Sebelius to appropriate this many-zeroed figure was run by Democratic supermajorities, and this one isn’t.

Third, insofar as Republicans favor redistributive intervention in the health-insurance market, they have historically favored things like subsidies for those with the kinds of preexisting conditions that render it highly difficult or impossible to get coverage on the open market. Indeed, the Republican alternative to the bill that became Obamacare included $25 billion for high-risk pools.

Last, the bill is loaded with potential political upside: Its whisks away money that would have otherwise been used not just to implement Obamacare, but to sell its implementation to the public. It forces Democrats and the president, should they oppose it, to explain why they think Obamacare funds are better spent creating bike paths than covering tens of thousands of uninsured. And it gives Republicans something tangible they can point to in their rolling effort to transform themselves from a “”Party of No” to a party of constructive alternatives.

Of course, this last point returns us to the question I began with: If stopping Obamacare remains the overarching goal of the Republican party, does legislating from within its framework, even to subversive ends, help or hinder that overarching goal? Conservative critics, such as the folks at Club for Growth, argue it’s the latter. Even if high-risk pools are good policy, they say, the particular high-risk pools created by Obamacare are so structurally flawed that even Democrats are abandoning them — they ran so far over-budget that the government stopped taking new enrollees.


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