The healthcare test for Rep. Stefanik: First do no harm

Update:  Elise Stefanik’s press aide, Tom Flanagin, has reached out to the In Box to point out that the congresswoman explained her vote in a Facebook post, which I hadn’t seen when writing this essay.

“I am pleased that this vote today requires the House to develop an alternative approach to the President’s healthcare law,” she wrote.  Rep. Stefanik praised the legislation for including a list of specific agenda items for what a replacement for the Affordable Care Act might look like.

To be clear, however, the bill which passed the House (HR 596) doesn’t mandate any timeline for House committees producing such a replacement piece of legislation, not does it offer any specificity for what a bill or multiple bills might look like. 

PREVIOUSLY

Earlier this month, when Republicans prepared to vote yet again on repeal of the Affordable Care Act, New York Congressman John Katko made it clear that, in his view, the ground in the healthcare debate has shifted.

“During the course of my campaign I said that I think Obamacare is a mess and I think you have to use the word ‘train wreck’ quite a bit,” Katko said, according to the Auburn Citizen newspaper.

But the Republican added a point that seems worth dwelling on:  “I still believe that,’ he said.  “But I also said that it would be irresponsible to just vote for repeal of Obamacare without having a viable replacement ready to go.”

Keep that word, irresponsible, in your mind as you work through the rest of this essay.

Here’s the reality Katko is describing.  When Obamacare was first signed into law, it was an abstraction, a policy idea that was – to say the least – deeply controversial and deeply flawed.  But half a decade later, the ACA is simply how we do healthcare in America.

A report issued last week found that roughly 2 million New Yorkers, many of them here in the North Country, now rely directly on the various provisions of Obamacare for their coverage.

Let me say this again more clearly:  More than 10% of New Yorkers rely on the ACA for this most basic of services.  That includes working families, children and business owners.

Independent surveys suggest that 20 million Americans have gained insurance since 2010 because of this one policy, cutting the rate of the uninsured in our society by a third.  That’s not to say that ACA is perfect or the best way for healthcare to be structured in the US.  People across the political spectrum find a great deal to dislike about it, as do many doctors and hospital administrators.

But it is now the system that we have and not merely an expression of Barack Obama’s political brand, or a meme on Fox News or a punching bag for Rush Limbaugh.  Knocking it down without having any actual policy ready to replace it would produce something like chaos.  The truth is, no one’s really sure what would happen.   We’d be flying blind.

Yet last week, Republicans voted nearly unanimously to do just that.  For a 56^th time, the GOP tried to yank the plug on the ACA, without having any specific, politically viable idea of how to replace it.

In late January, during a visit to Lake Placid, Rep. Stefanik acknowledged that some kind of plan is needed.  “Republicans have a responsibility to put forth a replacement package,” she said, according to the Adirondack Daily Enterprise.  Yet less than a month later, she voted with the GOP to dismantle Obamacare without any plausible, realistic Plan B on the table.

After half a decade, back to the drawing board?

What’s more, there is absolutely no evidence to suggest that a real-world policy proposal will emerge from the Republican side any time soon.  During an appearance late last month on CBS’ news magazine “60 Minutes,” the two most powerful Republicans in the country again trotted out the old complaints about the ACA.

But asked repeatedly how it would be replaced, they fired blanks.

“I just think it’s time for us to look at this differently,” said House Speaker John Boehner.  “We’re working on this, having discussions among our members, we’ve got a lot of divergent views about how best to go back to a doctor patient relationship that’s revered.”

Pressed to be more specific, Senate Majority Leader Mitch McConnell again launched an attack against Obamacare.  “We ought to pull it out root and branch and start over,” he said.

But why are Republicans only “starting over” now, half a decade after they decided that the ACA was intolerable and unworkable?  Despite the existence of a vast network of think-tanks and very smart conservative thinkers – including Rep. Stefanik herself – we’re still very close to a complete blank slate in knowing what the GOP would do next.

Moving beyond the back of a napkin stage

To be clear, there are some conservative ideas floating around about possible alternatives to Obamacare.  In fact, there are several rough drafts of plans.  They’ve shifted and evolved and grown, and some of them include some very interesting proposals, including strategies for closing the uninsured gap that don’t include unpopular mandates.   They’re all worth debating and considering.

But good ideas are not good bills.  And good pieces of legislation do not automatically translate into meaningful political action.  In fact, they rarely do.  And so far, the GOP has shown zero willingness to spend their political poker chips to accomplish what the Democrats managed to do in 2010:  That is, actually governing.  Actually pushing through functioning, real-world legislation that might address a huge real-world problem.

Indeed, there’s reason to believe that the GOP may still not be particularly serious about getting this done, that the rough-draft plans now being touted in press releases have more to do with politics than policy.

It’s fair to point out that Republicans find themselves in a strategic and philosophical bind that they hoped desperately to avoid.  As Sen. McConnell acknowledged, perhaps inadvertently, the ACA has put down deep roots and sprouted broad branches.  The policy now directly affects tens of millions of Americans and, through its safe-guard regulations, indirectly affects many tens of millions more.

Obamacare has, in the parlance of diplomacy, become a fact on the ground.  It is how we live our lives.  It is how your neighbors are getting their check-ups, how the college kid who works in your shop in the summer gets his broken leg fixed, and how the small business owner who works out of his home can now afford to pay for her prescription drugs.

Before Republicans – and Rep. Stefanik – vote a 57^th time to dismantle the system, they owe it to their constituents to show us they would move forward if this architecture is scrapped.  We get the repeal part.  Now it’s time to roll up your sleeves and detail the replace part.

Obviously, those steps are much harder.  And as Speaker Boehner acknowledged, the GOP remains deeply divided on what those next steps should look like.  But that’s what governing is about, especially when you’re the party that controls Congress and when you’re talking about a part of government as central to our moral lives as caring for the sick, the working poor, and the vulnerable.

Looking for Stefanik’s new ideas

For Elise Stefanik, this obligation is a personal one.  She is one of the most compelling new political voices in Washington.  She has made her opposition to Obamacare a central part of her political identity.  And she has repeatedly promised bold new ideas.

So rather than waiting for some kind of consensus to emerge at long last, from her party’s leaders, why not put out her own detailed proposal?  Even if it’s unlikely to pass or be signed into law, it might spark a new conversation.  And it would be reassuring to her constituents, many of whom rely on the ACA.

Some might say that it’s too early.  Rep. Stefanik has only been on the job for a month.  But if she’s prepared to vote to dismantle the ACA, shouldn’t she be prepared to tell us with some detail and with some specificity how she wants to see it replaced?

While we wait for that kind of detailed plan, the stakes keep getting higher.  The current enrollment period for the Affordable Care Act ends Feb. 15^th.  It’s likely that millions more will sign up.  For those American, this won’t be a political abstraction or an ideological talking point.

It will be how they care for their kids, their spouses, their employees, and (yes) even for their neighbors and fellow Americans who are in need.   Before Republicans unravel all that, they need to do their homework and show us their math and put a plan on the table that might actually move us toward something better.  To do anything less would be, as Rep. Katko suggests, irresponsible.