Interestingly, it’s Cathy McMorris-Rodgers’s comments about “reforming” rather than repealing the O-Care exchanges that drew most of the blog chatter this weekend, not Rand’s equally eyebrow-raising remarks at Harvard on Friday. Is that because McMorris-Rodgers is guilty of a double heresy, having forecast a new amnesty push this summer too? Or is it because Paul’s conservative bona fides are still in good standing whereas no one trusts the House leadership on anything anymore, starting with ObamaCare? Whatever the reason, McMorris-Rodgers issued a statement this morning aimed at the gullible optimists among us insisting that she’s on Team Repeal all the way. Whew.
What about Rand, though? I can’t find video or a transcript of what he said in Cambridge; National Review says that he reiterated his strong opposition to ObamaCare but was fatalistic about repealing it — in the near-term at least. The Hill’s account makes it sound like his time horizon was longer than that, though:
“I think it’s going to be difficult to turn the clock back. People get assumed and accustomed to receiving things, particularly things that they get for free,” he told a crowd of students at Harvard’s Institute of Politics on Friday…
“I think one of the practical things you might be able to do, and I think the public at large might accept this, is to make ObamaCare voluntary. You make it voluntary, basically you get rid of the coercion,” he said, presumably by eliminating the penalty those without insurance are required to pay, known as the individual mandate.
He said he may keep some parts of the law, like the subsidies to help poor Americans afford insurance, or the Medicaid expansion — two of ObamaCare’s more popular provisions but potentially its more expensive.
“Does that get rid of the subsidies? Not necessarily, or the Medicaid. But I think also we’re going to find out we can’t afford to have everybody on Medicaid, we can’t afford to have everybody on subsidized insurance,” Paul said.
Alternate headline: “Ted Cruz’s ad team pulls all-nighter” — which would be ironic, since Paul’s logic here about the difficulty of weaning people off subsidies once they’ve begun is the same as Cruz’s was back in October in pushing the “defund” effort (which Paul tepidly supported). All Rand’s saying, really, is that repeal becomes much harder once a program’s in place and people have come to rely on it. Cruz couldn’t agree more, I assume, which is not to say he won’t have lots of fun punishing Paul for his “defeatism” in the primaries.
In a sense, all he’s giving you here is the ObamaCare version of his straight talk on abortion with David Axelrod. America’s not going to change its abortion laws, he said, because there isn’t enough consensus to do so. There may be enough consensus to draw a firm legal line at third-trimester abortions but there certainly isn’t a consensus for an all-out ban like social cons want. The trick for voters is deciding how much of that statement is descriptive and how much is prescriptive. How much political capital would President Paul devote to shaping a consensus on abortion? How much would he devote to shaping a consensus on ObamaCare’s repeal? The first requirement of a tea-party champion is that he resist establishment conventional wisdom and fight for his principles, even if he’s all but guaranteed to lose. It was Cruz’s insight that he could win politically that way by leading on “defund” even though he was destined to lose on the merits. I don’t know why, frankly, Paul would leave himself open to attacks from Cruz on that point by taking these quasi-fatalistic views about hot-button conservative issues. Presumably it’s because his top priority is showing the establishment that he can play nice, and hinting that he wouldn’t rock the boat terribly much on abortion and, especially, ObamaCare is one way to do that. But he’s got to get through the primaries first. Why make things easier on Cruz?
As for the merits, I don’t think repealing the mandate would do much to weaken the overall law at this point. It would be a moral victory insofar as it jettisoned the most overtly coercive element of O-Care, the one that got away at the Supreme Court two years ago, but yanking it out of the ObamaCare jenga tower now wouldn’t topple the whole structure. That might have happened if the Court had struck it down before the exchanges launched; without the mandate in place scaring twentysomethings into buying insurance this year, the risk pools might have been overloaded with the old and sick, premiums might have shot up in 2015, and suddenly we’re in death-spiral country. As it is, they’ve got somewhere between six million and eight million paying customers enrolled, roughly 28 percent of whom are “young invincibles.” That’s well short of their target of 39 percent last year but enough that premiums aren’t expected to skyrocket next year to make up for missing revenue. But even if the mandate had been nullified by the Supremes, that still might not have nuked O-Care; remember, for all intents and purposes, the mandate has already been repealed. It’s basically hortatory, a nudge to adults (especially young adults) to sign up but not something that’s being seriously enforced. It was the White House PR outreach to twentysomethings that did most of the work in getting them to sign up, I think, not the mandate. In which case, what’s really achieved at this point by getting rid of it?
Exit question: If we drop the mandate and keep the exchanges and the subsidies and the Medicaid expansion, as Paul envisions, then we’re basically adopting O-Care, right?