When the Affordable Care Act was being debated in Congress, not a single Republican supported it. When the votes were cast, not a single Republican voted for it. In fact, the Democrats had to work especially hard to minimize the number of moderate-to-conservative Democrats who wanted no part of the bill. Yet the policies outlined in the legislation were clearly more moderate than anything else. In fact, many of the specific proposals were borrowed directly from the conservative playbook, while more progressive ideas like the public option were omitted entirely. Why, then, did the left work so diligently to pass this law, while the right fought it tooth and nail? The answer is one of politics, rather than policy, and looking at one part of the law–the health insurance exchanges–makes this point loud and clear.
As Julie Appleby writes for Kaiser Health News, “insurance exchanges have had both conservative and liberal support. Conservatives, including the Heritage Foundation, endorsed the idea of market-based exchanges as a way to promote competition among insurers, which would benefit individuals who buy their own coverage as well as employers who offer policies to their workers….Conservatives have also generally supported the idea that states would retain regulatory control….In the end, the Senate version became law in 2010 – but without the vote of a single Republican. As a result, few GOP governors wanted to be seen as supporting it, or moving forward on creating state-based insurance markets. Many waited until after the Supreme Court decision or the November elections before deciding which way to go – leaving insufficient time to build a state-based market if they had not already made some preparations.”
So, the exchanges are a conservative idea, widely supported in the past, and only shunned by Republicans once the Democrats warmed to the idea. And now, with the bill become law, red states are playing political games that will result in a less conservative version of the exchanges being imposed on them. In short, politics has turned good policy into bad policy, because no Republicans wanted any Democrats to do something to help the country that might, in turn, benefit the opposing party. That gives me the impression that politics have taken the place of advancing the common good, and that concerns me greatly.