What is behind the big House-Senate fight about defunding Obamacare?

CNN screenshot
Today the House is going to vote on a bill that would defund Obamacare for the sole purpose of sending it to die in the Senate. This is House conservatives’ way of calling the bluff of U.S. Sen. Ted Cruz, who has been preening and posturing about defunding the law, which is something that everyone including Cruz knows is never going to happen.

And in the past couple of days, our own Rep. Sean Duffy has emerged as one of the leading House voices attacking Cruz. He posted this on Facebook, sort of baiting the Senate:
Duffy FB comment

On Morning Joe just this morning, Duffy said this:

“I have to tell you what, you should have been on the floor back in the cloakroom. There was so much anger, so much frustration because, again, we’ve been abused by these guys for long,” Duffy said. “What I see happening now is people coming out and calling them out for the hypocrisy of these big, tough conservatives who know how to fight but will never get in the ring.”

In essence, Obamacare opponents like Duffy and Ron Johnson see Cruz’s stance as a pose, and they resent the way he has sort of swooped in to take the more-conservative-than-thou mantle from the House GOP. This bill the House is going to pass is a way of saying: Put up or shut up, old man. Oh, you can’t get your defunding bill through the Democratically-controlled Senate? Then stop bothering us and calling us RINOs in the House.

It’s a fair point, and it was good enough to rile up some of the right-wing defund-it-now types like Erick Erickson, and to get conservative gadfly Brian Sikma to tweet this:

Yeah, well, good luck, I guess, with the tea party primary challenge. I would say he is not quaking in his boots about that one.

What about the substance?

There is always something interesting about intra-party battles, but this is all about tactics. Let’s have a reality check about the substance of what we’re talking about.

It is a little bit absurd to even talk about “Obamacare” as one thing, or even as a program that can be defunded in any literal sense. A lot of it doesn’t involve spending, just regulations. And a lot of the regulations in the law, meanwhile, are actually things that are pretty broadly popular.

You hear things like the end of preexisting condition exclusions and the ability of young people to stay on their parents’ insurance up to 26 cited a lot and they are good examples. But there are a lot more. It’s a big law!

  • The law cracks down on bogus or fly-by-night insurers by regulating how much, by percentage of overall income, they can spend on marketing vs. actual, you know insurance. This is not really something you can “defund.” It’s also a good idea that does not really effect legitimate insurers — in Wisconsin, virtually every company was already in compliance.
  • The law controls costs by putting in place a penalty for hospitals that have a high readmission rate for Medicare patients, creating an incentive for them to run better. In fact, readmission rates have fallen since the law was passed. Is this something we can or should “defund”? No, it is not.
  • The law puts in place a set of pilot programs that help nudge hospitals toward the Mayo Clinic-style pay-for-performance model that everyone agrees is a better way to provide better care more cheaply. Now, these programs could be defunded. But why would you want to?

I will have mercy on the reader, but believe me when I say I could go on for quite awhile with these.

Meanwhile, the law’s cost control mechanisms, which are crucial to make the insurance expansion work without bankrupting us, are actually working much better than expected. Nationally, health costs in the 12-month period ending in May rose at 1.1 percent — the slowest rate of increase in five decades. I guess you could argue that this is purely a coincidence but that would seem a bit silly.

Am I saying the law is all awesome with no flaws, handed down from heaven by my Obamamessiah? (Sorry, channeling some of the people who email me.) I am not. The already-delayed employer mandate is a messy and probably ill-advised policy. We can and should debate about whether some of the law’s taxes impose too great a burden on businesses, for example medical device manufacturers, which take a big hit. I have more of these sort of examples, too. (Big law.)

But isn’t the best way way to fix flaws in the law to, you know, fix the flaws?

In the real world, of course, “Obamacare” has come to signify one thing and one thing only, and that is the expansion of insurance coverage to millions of people who did not have insurance before. This is something that makes people very nervous because it seems (and in some ways is!) very expensive, and people are worried that the system isn’t equipped to handle it and it will end up making their own insurance worse.

I think that is a misguided view for several reasons. But leave these aside. When we talk about “defunding Obamacare” this is what we are really talking about: stopping the expansion of insurance to millions of people.

What is Cruz up to?

So, back to Ted Cruz. Is he just a dummy who doesn’t understand the law or what he is calling for? No, of course not. He is a really smart dude.

In his interview with Charlie Sykes yesterday, Duffy put his finger on what Cruz is up to:

I think what’s happening is, you have a senator who’s running for president, and he’s playing politics, not focused on Democrats Harry Reid and Barack Obama. He’s turned his fire on fellow conservatives, fellow Republicans and trying to have the fight internally.

I would add that the House vote ALSO allows Duffy and others to tell their right-wing base voters that they voted to defund Obamacare. So it’s both a way of taking Cruz down a peg while still protecting their own right flank with voters given to a more-conservative-than-thou mindset. Except for the parts where it is bad policy and probably makes a government shutdown more likely, it is a win-win.

About Robert Mentzer

I am the opinion editor at Daily Herald Media.
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