In other words, Republicans’ insistence that they have a superior alternative to Obamacare is a zombie lie — a claim that should be dead after having been proved false again and again, but it is still shambling along, eating people’s brains.
But why can’t Republicans come up with a better alternative to Obamacare? Are they just incompetent? Possibly — but even if they did know what they were doing, they couldn’t produce a superior plan, because no such plan is possible. In particular, unless you’re willing to move left instead of right, by going for single payer, the only way to guarantee coverage for Americans with pre-existing conditions is a system that looks a lot like Obamacare.
The logic here has been clear from the beginning. To ensure coverage of people with pre-existing conditions, you have to prohibit insurers from discriminating based on medical history. But that’s not enough: To provide a decent risk pool, you also have to induce healthy people to sign up, preferably with both subsidies and a penalty for being uninsured. In other words, you need a system that is basically Obamacare.
The 2017 tax cut, which did away with the individual mandate — the penalty for noninsurance — weakened the system; you can see this by the fact that states, like New Jersey, that imposed their own mandates saw a drop in insurance premiums. But the design of the subsidies, which insulated most people from rising premiums, contained the damage: The percentage of Americans without health insurance, which fell sharply as a result of Obamacare, remains near record lows.
So is there any alternative to Obamacare? Of course there is. We could go back to being a country in which people with pre-existing conditions and/or low incomes can’t get health insurance, where for a large fraction of the population illness either goes untreated or leads to bankruptcy. That would, in part, mean becoming a country in which Americans who caught Covid-19 during the pandemic would be uninsurable for the rest of their lives.
Indeed, turning us back into that kind of country is the G.O.P.’s true goal, and is what will happen if the party gets its way either as a result of the current lawsuit or through legislation during a second Trump term.
But Republicans can’t admit that this is their goal. The public overwhelmingly supports protection for Americans with pre-existing conditions, so right-wing politicians have to pretend they can provide that while dismantling the regulations and subsidies such protection requires. And they have to hope that voters won’t remember that they have been promising a plan, but never delivering, for more than a decade.
Let’s hope voters are smarter than that. Fool me once, shame on you. Fool me 70 times and counting, shame on me.
The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: firstname.lastname@example.org.