Health Insurance

The Pottery Barn theory of Obamacare: you break it, you buy it

Sarah Kliff
Watch Berkshire
Republican Representative from North Carolina Mark Meadows speaks to reporters after a meeting of the House Freedom Caucus to discuss the healthcare bill on Capitol Hill in Washington, DC, on March 23, 2017.
Nicholas Kamm | AFP | Getty Images

In an interview earlier this month, President Trump told the Washington Post, "The best thing politically is to let Obamacare explode."

The theory here is that an Obamacare explosion would reveal massive problems in the law Democrats passed, and voters would blame the minority party for the failure.

The data, however, does not agree with Trump. A new Kaiser Family Foundation poll finds that most voters (61 percent) say it would be Trump and the Republicans' fault if Obamacare stopped working.

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"People think that the current government is the government in charge, and they own it," says Kaiser Family Foundation president Drew Altman.

It's kind of like the Pottery Barn rule: You break it, you buy it. And this makes sense when you step back and think of how nutty Trump's theory is here. There is no historical example of a political party riding to electoral victory on the back of a poorly run entitlement program. Of course voters will blame the people in charge when something goes wrong with their health insurance.

Matt Yglesias put this especially well during a recent episode of The Weeds, the podcast we co-host.

'"You can go through history books and there is no version of, 'And the president did this thing that he knew would make people's lives worse not just because it was worth the cost but because he saw partisan political advantage in making people suffer willfully,'" Matt says. "It's ridiculous."

KFF also provided me with a more in-depth breakdown of how Republicans feel about this particular issue — would they also blame Trump if Obamacare were to go astray?

The numbers there are a bit different: 56 percent of Republicans would say Democrats are responsible for any problems going forward, while 34 percent would blame Republicans (the rest either said they didn't know or refused to answer the question).

"That is a majority of the GOP who still view it as the responsibility of Democrats, but it is a small minority," Altman says. "In the world of ACA polling, that is not a high number. Usually Obamacare disapproval is in the 70s or 80s among Republicans."

Among independents, meanwhile, many are ready to blame Republicans for any future Obamacare woes. Sixty-five percent in the KFF poll said they thought the party would be responsible for problems moving forward, compared with 30 percent who saw Democrats as the culprits.

Meanwhile, on Capitol Hill, we check in on the Freedom Caucus soap opera

Trumpcare 1.0 survived about three weeks before Republicans decided it couldn't pass the House.

Trumpcare 2.0 — the rebooted effort at repeal — is on track to last about three days.

Health care talks are once again stalled on Capitol Hill after a late-night Tuesday meeting failed to create any consensus. There will be another meeting today, but as Vox's Dylan Scott points out, "it's not clear what there is left to do."

The problem Republicans have now run into is one that won't be easy to solve. Republicans don't agree on what the goal of their health care effort is.

The conservative Freedom Caucus says the goal is deregulating the health insurance marketplace, to drive down the cost of health insurance in the individual market. These House Republicans generally seem to think it would be okay if this leads to a significant loss in coverage.

The more moderate Tuesday Group has been less clear on its demands. It doesn't operate like a bloc in the way the Freedom Caucus does, so different members might have different priorities. But generally, these moderates are not okay with really significant coverage loss and seem to care less about deregulating the insurance market.

The White House strategy to get both groups on the same page did not seem especially strong. Politico reports that Vice President Mike Pence simply described the same policies differently to the two different factions. The Freedom Caucus says they were told, for example, that the new proposal would once again allow insurers to charge sicker patients higher premiums in the individual market. The Tuesday Group, however, heard something different: that premiums would only be allowed to vary by age, not by illness.

This whole strategy fell apart, obviously, when the two groups of legislators spoke to each other.

Dylan has a more in-depth piece on the state of play on the Hill, which you should definitely read. My takeaway is this: Getting these two groups on the same page is going to take more than strategy. It will require convincing a few dozen Republicans to revise some pretty deeply held policy positions. Either the Freedom Caucus will need to become okay with keeping most Obamacare regulations — or the Tuesday Group will have to get comfortable with more coverage loss.

Kliff's Notes

With research help from Caitlin Davis

  • "White House downplays hopes new ObamaCare bill will be ready soon": "The bill to repeal and replace ObamaCare was withdrawn before a vote last month amid opposition from conservative and centrist Republicans. The new effort is being led by Vice President Pence, and administration officials have told the Freedom Caucus and Tuesday Group that changes were being made. A broad coalition of Republicans met with Pence late into the night on Tuesday. But they emerged no closer to an agreement, and without any text." —Nathaniel Weixel, the Hill
  • "Conservatives outside Congress say latest health-care revision push has foundered": "'It was very close a couple of days ago, but it looks like things have gone in a bad direction,' said Heritage Action for America chief executive Michael Needham on a Wednesday morning call with reporters. Needham placed the blame squarely at the feet of moderates: 'It's kind of stunning that in 24 hours, instead of building support for good policy, they've kind of abandoned it.' Needham's remarks — as well as recent signals from the Club for Growth and other conservative activist groups — represent a new effort to shift blame away from the conservative hard-liners whom President Trump, House Speaker Paul D. Ryan (R-Wis.) and many other Republicans had criticized for the failure last month of their long-promised health-care overhaul." —Mike DeBonis and David Weigel, Washington Post
  • "Crushed by defeat, patients and providers vow to fight on to expand Medicaid in Kansas": "The failed veto override also crushed hospital executives and community clinic directors who had hoped against hope for a Medicaid expansion, which would have brought in a flood of federal dollars to help pay for the care they now often deliver for free. The expansion would have covered an estimated 150,000 Kansans. Activists, including the Kansas Hospital Association, promised to keep fighting." —David Steen Martin, Stat News
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