Democrats have a golden opportunity to save Obamacare and pick up political credibility at the same time.
With House Speaker Paul Ryan’s vision for the American health care system being rejected by the left, the center and the right, Democrats should offer their own plan to bring relief to those who are paying more or getting less under President Barack Obama’s signature law.
Ryan’s proposal is simultaneously a relatively light rewrite of Obamacare for those who buy private health insurance with government subsidies and a radically punitive assault on Medicaid, the program that provides health care for the poorest Americans and the disabled.
Maybe Ryan missed the memo, but the American public has grown more populist in recent years. A health care law that punishes the poor in the name of tax cuts for Wall Street investors is hardly the cure that Americans have been demanding.
Instead of addressing the public’s desire for quality health care at a price that is both affordable for the individual and for taxpayers collectively, he is holding the GOP and the nation hostage to the twin dogmas that define his political philosophy: America does best when the wealthy pay as little as possible in taxes, and poverty is both the result and cause of moral turpitude.
Ryan likes to talk about the “poverty trap” of government entitlements. In his view, people choose not to work and earn money because they have health insurance. That’s nonsense.
It’s no wonder the U.S. Conference of Catholic Bishops has declined to endorse the bill and, in a letter, wrote this: “Any modification of the Medicaid system as part of health care reform should prioritize improvement and access to quality care over cost savings.”
Democrats are in lockstep against Ryan’s bill. Several Republican senators have criticized the bill’s treatment of Medicaid. And members of the House Freedom Caucus, backed by conservative Sens. Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah, have said that it doesn’t keep faith with the GOP’s promise to unravel Obamacare. Outside groups from The Heritage Foundation to the Tea Party Patriots agree with them.
With Republicans predictably divided over their effort to do something anathema to the party — write legislation providing for a major entitlement program — Democrats should step in and do it for them.
By providing a serious alternative, Democrats could give Trump the choice of moving toward them for a deal or sticking with a foundering Republican plan. If he chooses the former path and it works, Democrats will get credit for working with the president and Trump will get his repeal-and-replace law. If he stays in a partisan corner, he’ll end up with either nothing or a law that takes benefits away from Americans who voted for him.
After all, a lot of Medicaid beneficiaries are non-college-educated whites at the core of his base.
The safest path is for Democrats to sit back with popcorn and watch this campy horror film play out, knowing that Trump and Republicans will be blamed no matter what. But if they truly care about preventing regular folks from taking a devastating hit — and the richest Americans from consolidating wealth at the expense of the poor — they’ll offer a serious substitute bill that addresses the shortcomings of Obamacare.
Moreover, they should do it in a way that offers an olive branch to deficit hawks in the GOP who would like entitlement programs to become more sustainable without hurting the least among us. The Democrats’ alternative should open the door to refining Medicare and Social Security. Rather than taking away from those who have benefited under Obamacare, the alternative should expand the pool of those who get assistance. That means increasing the income thresholds for subsidy eligibility.
At the same time, they should lift or eliminate the cap on Social Security taxes, which would provide a revenue windfall. In addition, Social Security benefits should be paid out on a more progressive basis — with those at the upper end of the income and wealth scales getting less or nothing while those who have need and have paid into the system getting what they were promised. Medicare benefits could also be made more progressive.
In the short term, revenue and spending for entitlements would rise; in the long term, those programs would be changed to restrict their growth and provide benefits to those who truly need them.
In short, Democrats may never have a better time to seize the middle ground, protect benefits for the lower and middle classes, and ensure that all Americans have quality health care. They can pin Ryan and his House Republicans into their ideological corner and produce both policy and political victories.
That is, they could do well by doing good. The lesson Republicans are now learning is that you can win power by denouncing the other side, but you can’t govern without a real plan. Democrats should take note of that and come up with a progressive, modernized proposal that appeals not just to Trump but to a broad cross-section of American voters.
Roll Call columnist Jonathan Allen is co-author of the New York Times-bestselling Clinton biography “HRC” and has covered Congress, the White House and elections over the past 15 years.