Debate About Obamacare Has Gotten Healthier

Some Kentucky Republicans may be creeping toward tweaking Obamacare. Photographer: Andrew Harrer/Bloomberg

One more thing from that excellent article about health-care reform in Kentucky. Some Republican politicians from the Bluegrass State are pushing full Obamacare repeal, and that's what they are going to support at the national level for a long time -- at least in their rhetoric.

But some state Republican legislators are planning something else:

[State Senator] Robert Stivers described a gradual process to reduce Kentucky's participation in the health care law. He suggested, for example, that Republicans pare down the Medicaid expansion under the program, which currently covers people as long as their income is less than 138 percent of the federal poverty level, in increments, bringing it down to perhaps 130 percent initially, then a lower number after that. (The Obama administration has long said it would not support such a partial expansion of Medicaid.)

Stivers isn't suggesting repeal. He just proposes cutting the portion of Medicaid that was expanded under the Affordable Care Act. In other words, what we're seeing here is the return of health care as a normal issue -- one on which Democrats and Republicans strongly disagree on funding levels and other specifics, but where the basic parameters of current law are a given.

That would involve Republicans settling for short-term improvements (as they see it) in health care when they could find them, rather than putting their energy into undermining the law to force its collapse either in policy terms or politically.

After all, a vote by the Republican-majority Kentucky legislature to scale back Medicare expansion, with federal approval to do so, would amount to explicitly accepting some Medicare expansion. Trying to have it both ways has tripped up Republican politicians, most famously House Majority Leader Eric Cantor, with his failed initiative to support the high-risk pools that conservatives had previously supported but were now part of the hated Obamacare. The shift, then, would be from hoping to make things worse (because only then could they get better) back to the normal politics of trying to get the best available outcome right now.

Sooner or later, it's very likely that Republicans will make that transition. In actions, if not in rhetoric. And it will be a very healthy development.

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