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.
More broadly, since the bill became law, and since neither the Supreme Court nor the presidential electorate intervened against it, many conservatives have been arguing that the best way left to beat Obamacare is to let it “collapse under its own weight.” No need for Republicans to have their fingerprints on a murder weapon, they argue, when the law is doing a fine job of killing itself.
Is it? To be sure, Obamacare is not going particularly well. No less a figure than Senator Max Baucus (D., Mont.), who, as chairman of the Finance Committee, did as much as anyone to shape the Affordable Care Act, warned that the law could turn into a “big train wreck” if changes are not made and implementation is not delayed. So concerned was Baucus that, a week later, he surprised the Beltway by announcing he did not intend to stick around as the senior senator from Montana to find out if he is right.
But, as the law’s supporters are quick to complain, the implementation snafus are at least in part due to Republican obstructionism. As Peter Suderman points out over at Reason, they should not have expected anything else:
The law was written — by Democrats — to give every governor the choice to either set up an exchange or let the federal government do so. If the law wasn’t going to work if some governors opted out, then the fundamental problem is bad legislation, not political opposition.
As for political opposition, Democrats failed to account for that too. It’s bad policy design to build and pass a law that relies on the assent of a determined political opposition in order to work. . . . Democrats never really had a plan to deal with Republican opposition to Obamacare, except to hope it went away. That was a pretty stupid plan. And Democrats deserve responsibility for going with it.
It’s odd, then, that some of the same conservatives who think H.R. 1549 is bad legislation are happy to credit Republicans for stymieing Obamacare by refusing to participate in the exchanges. What they don’t realize, and what Suderman’s point makes clear, is that the two are different tactics in pursuit of the same strategy. Republicans at the state level have not had success by nullifying the law, nor, by and large, by challenging it in court. They have had success by revealing a feature of the law to be a bug — that is, by essentially hacking Obamacare. Supporters of H.R. 1549, too, are attempting to exploit design flaws to destabilize the new health-care regime.
The exchanges stuff might come off as more noble to some, because it at some level resembles the kind of open resistance that, even when doomed, we tend to respect and romanticize — For Whom the Bell Tolls and all that. Supporters of H.R. 1549, by contrast, feel more like the weaselly collaborators who tell you they’re doing everything they can to undermine the bad guys, even as they’re wearing the bad guys’ uniforms. A similar dynamic is playing out in the debate over the Medicaid expansion: Republican governors who refuse to participate are lauded by much of the Right as heroes, while those who sign on to the expansion, largely due to local political incentives, are shouted down, even as they argue that they can better limit the damage of federal encroachment from within than they could from without.
The truth is there is something to both approaches: Resistance comes in many forms. The trouble is that you always know where the guy defying from without stands. The guy undermining from within is necessarily cagier and harder to read. Is he looking out for the cause, or for himself?
— Daniel Foster is news editor of National Review Online.






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