Jay Bookman

Opinion columnist and blogger at The Atlanta Journal-Constitution, specializing in foreign relations, environmental and technology-related issues

Opinion: The big question about health care is now answered


The leading Republican candidates for the open 6th Congressional District this week reiterated their pledge to go to Washington and rid the country of the scourge of Obamacare.

"I’m going to deliver finally on repealing and replacing Obamacare," said Karen Handel, as if she alone could pull off what the election of a GOP House, Senate and president has so spectacularly failed to accomplish.

“To stop, and not move forward repealing and replacing Obamacare is wrong," said former state Sen. Judson Hill, the man who in 2007 championed state legislation that read as a virtual blueprint for what later became Obamacare, right down to government-run exchanges and individual mandates to buy insurance.

Up in Washington, House Speaker Paul Ryan was making similar noises, warning his fellow Republicans that if they didn't come up with a deal, President Trump might start making deals with the Democrats.

It's enough to make a person laugh. For all intents and purposes, the health-insurance war is over and the conservatives lost. All that remains is negotiating the terms of their surrender, and the sooner they come to that realization, the better it will be for their party and more importantly for the country as a whole.

It is over because the American people, as a whole, now overwhelming accept the basic argument that some form of health insurance is a necessity and a right, even for those who cannot afford it for themselves. An overwhelming and growing majority of Americans also agree that government should be the last-ditch guarantor of that right to health care. You can cite a lot of reasons for the GOP's spectacular, ongoing failure to repeal the Affordable Care Act, including its own incompetence and arrogance, but the main reason the effort failed is because voters will not accept a plan that strips health insurance from 24 million of their fellow Americans, and they have made that fact known in no uncertain terms.

In a Pew poll taken in January, for example, 60 percent of Americans agreed that "it's the responsibility of the federal government to make sure that all Americans have health care coverage." Just 38 percent disagreed. More to the point, 52 percent of Republican voters making less than $30,000 a year also agree with that statement, up from 31 percent a year ago. Those are the folks whose lives are at stake in this debate, the people who have benefited from having health insurance. They are also the voters likely to switch sides if that access to health care is taken away from them.

In whatever passes for his heart, Trump knows that. He ran throughout the GOP primaries and in the general election on the promise of repealing Obamacare, with the important additional promise that he would still provide coverage to everybody. He had no idea how that promise might be kept; at that point, he was still many months from grasping the amazing fact that hey, health care is complicated. But Trump at least understood the goal and how deeply the American majority now bought into it.

Take Medicaid expansion, a key accomplishment of the Affordable Care Act that has helped insure some 11 million lower-income Americans and also has helped to stabilize the health-care industries in the 31 states that have embraced it. When the House GOP announced plans to reverse that provision, it inspired a broad backlash from Republican governors, hospital groups, the American Medical Association and just about anybody involved in the health-care debate from a non-ideological perspective. The 17 percent public-approval rate for the GOP bill can largely be attributed to its proposed dismantling of Medicaid, and even if the bill had managed to pass the House, the Senate would never have accepted that provision.

Look what has happened since the House bill crashed and burned. By 25-14 in the Senate and 81-44 in the House, the GOP-dominated Kansas Legislature voted this week to expand Medicaid in their state, forcing the hapless Sam Brownback to veto it. Similar expansion efforts are underway in Maine, Virginia, North Carolina and even here in Georgia.


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About the Author

Jay Bookman writes about government and politics, with an occasional foray into other aspects of life as time, space and opportunity allow.