Here’s the most charitable interpretation of the Republican case against Obamacare: The law’s changes to the individual insurance market have left people in that market worse off than before, by mandating broader, more expensive coverage and forcing people to buy it. Accordingly, whatever it takes to reverse those changes serves the interests of the people who are affected.
It’s especially important now for Republicans to be able to make that case. The U.S. Supreme Court is about to rule on whether the law allows people in states that haven’t created their own Affordable Care Act exchanges to receive the federal subsidies that make insurance affordable - a decision that could affect 8 million people. If the court strikes down those subsidies and Republicans refuse to reinstate them by amending the law, the party’s only palatable defense is that it is refusing to save a system that most consumers don’t like.
Here’s the problem with that argument: It’s wrong, and the data show it’s wrong. A poll released Friday by the Commonwealth Fund finds that 81 percent of people who have coverage through an exchange are happy with their insurance. (Previous surveys have shown similar results.) That’s partly because 53 percent of those who now have coverage through an exchange were previously uninsured - the vast majority of them for a year or more. It also means that even among those who already had insurance, most like the new system.
It’s worth considering what those numbers mean for Republicans. If the party isn’t responding to the preferences of people who buy insurance on the individual market, what justification is there for refusing to save that market from a court ruling?
Republicans could try arguing that average consumers don’t know what’s good for them. That wouldn’t be a novel position; it’s arguably what underlies Democrats’ insistence on defining so widely the benefits insurers must offer. But it would certainly be novel for the party of the free market and the wisdom of the individual.
Absent that, Republican indifference to what the average consumer of individual health insurance actually wants boils down to one of two things. The unsavory interpretation is that Republicans are holding hostage the health insurance of 8 million people in order to force Democrats to weaken the law. The even more unsavory interpretation is that Republicans aren’t really even negotiating - they’re simply sacrificing the insurance of 8 million people because doing otherwise would upset their core voters.
And so we come back to what’s been obvious for years: Republicans aren’t opposed to Obamacare because it’s not working. They’re opposed to Obamacare because it runs counter to their preference for small government and low taxes, which leads to the view that the government shouldn’t raise taxes in order to provide health insurance for those who can't afford it.
There’s nothing illegitimate or offensive about that philosophy. (Not unless you’re a John Kasich Republican, anyway.) What’s offensive is Republicans’ unwillingness to admit it and instead pretend that their goal is protecting those who use the market Obamacare transformed. Because those people seem just fine with things the way they are.
