Morality.

Photographer: Kent Nishimura/AFP/Getty Images

GOP Finds a Moral in Obamacare

Francis Wilkinson writes editorials on politics and U.S. domestic policy for Bloomberg View. He was executive editor of the Week. He was previously a national affairs writer for Rolling Stone, a communications consultant and a political media strategist.
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In an interview with Ezra Klein at Vox.com, President Barack Obama briefly alluded to the "moral basis" of Obamacare.

[With] the Affordable Care Act, a lot of the attention's been on making sure that the uninsured have peace of mind, and people who currently have insurance but at some point might lose it or have pre-existing conditions are going to have it. That's obviously the moral basis for what we did.

Obamacare was devised to accomplish multiple goals: to change the structure of the health-care system so that payments prioritize quality of care over quantity of care; to slow the rate of increase in health costs; to make health insurance more portable, decoupling it from employment. But the most salient and longstanding goal of Democrats -- the one they pursued for decades -- was expanded access to health care and to the "peace of mind" that accompanies it.

Obamacare and its precursors (Kennedycare, Hillarycare, Romneycare) were rooted in a liberal moral vision -- that no one in so wealthy a nation should be denied health care because they lack the means to buy it. Many Americans accept that premise. Republicans have all but ceded the argument; they just don't like the redistributive consequences of it.

Rather than combat the morality of Obamacare head-on, conservative opponents typically divert their attacks to adjacent playing fields: Obamacare is government overreach. It's bureaucratic. It threatens American exceptionalism. It will destroy jobs and the economy. Such arguments, ranging from practical to philosophical to foolish, have helped to raise public doubts about the efficacy of Obamacare. But they rarely challenge its moral foundation.

Perhaps no one in the Republican Party is better equipped to make the libertarian argument against universal health insurance than Senator Rand Paul of Kentucky. Remarkably, he doesn't. Last month, Fox News anchor Greta Van Susteren asked Paul, "What would happen to the American people?" if Obamacare were repealed.

"We could try freedom for a while," Paul replied. After his ideological shout-out, however, Paul proceeded to make a case for continued government subsidies in the health-insurance market:

Nobody's talking about a time when the government doesn't participate at all. Even before Obamacare the government did take care of the bottom 5 or 10 percent of our public who were on Medicaid. And then there was also charity. So there are different ways that we take care and help the poor. Nobody's saying we wouldn't still do those things if we didn't have Obamacare.

In 2010, when Obamacare was enacted, 15.9 percent of Americans (48.6 million) were on Medicaid and 49.9 million Americans lacked health insurance, according to the U.S. Census Bureau. Obamacare was designed to reduce the ranks of the latter group in part by expanding the ranks of the former. It's working. The percentage of uninsured Americans has declined dramatically in the past year and half. (Had more Republican-led states accepted Obamacare's Medicaid deal, the decline would almost certainly be starker.)

If Paul accepts the moral legitimacy of government providing some poor people with health insurance -- even his "5 or 10 percent" adds up to millions -- then how does he justify leaving millions of others out in the cold simply because they're too poor or sick or unlucky or young to afford insurance?

He doesn't. Like many of his Republican colleagues, Paul conjures a world of vague "different ways" in which millions who were unable to obtain insurance in the past are somehow able to access it after Obamacare is repealed. This world exists only as a rhetorical construct of Republican politicians who are unwilling to own the moral consequences of their preferred health insurance policy -- a modified (few can tell you how) status quo ante that, in the real world, would leave tens of millions uninsured.

It's a more difficult act for Republican governors than legislators. While still disavowing Obamacare, Tennessee Governor Bill Haslam said in December that expanding coverage to the uninsured is "morally and fiscally the right thing to do." The moral consensus, implicit and otherwise, on expanding access is so widespread that Louisiana Governor Bobby Jindal has been trying to distinguish himself by stating that "fixating" on expanding coverage is the wrong approach.  

Five years of sustained Republican outrage over Obamacare has yielded no replacement because it would require conservatives to either publicly capitulate to the moral logic of Obamacare, or renounce it. Random policy forays aside, Republicans remain frozen between those poles, hoping the Supreme Court will settle the conflict without forcing them to make a choice between a morality they claim to embrace and the policies that suggest they don't.

This column does not necessarily reflect the opinion of Bloomberg View's editorial board or Bloomberg LP, its owners and investors.

To contact the author on this story:
Francis Wilkinson at fwilkinson1@bloomberg.net

To contact the editor on this story:
Zara Kessler at zkessler@bloomberg.net