As most people who follow the news even a little bit know by now, the Republicans managed to twist arms and make deals to such an extent that they got 51 of their members to vote for it at 2:00 a.m. Saturday morning.

Yippee!, Republicans.

In the end John McCain voted for the bill, and so did Susan Collins and Lisa Murkowski and Jeff Flake. The ‘mavericks’ and stalwarts that you could count on to show a little bit of backbone in the past were all co-opted.  Only ‘little’ Bob Corker voted off.[1]

Forget about the $1.5 trillion that they’re adding to the deficit, that they were still scribbling amendments by hand well past midnight, that no one had read the bill before they voted on it, that Republicans abused the budget reconciliation process to avoid a filibuster, and that they treated ‘regular order’ like they had never heard of the concept.  Forget about all that.  As part of their proposed tax overhaul, Republicans in the Senate also revived the repeal of the individual mandate, the core feature of the Affordable Care Act (a.k.a. ‘Obamacare’).

As loyal readers of the blog already know, I have posted extensively on the Affordable Care Act, what it does and how it came into being. Let’s just review the highlights:

• The individual mandate is a Republican idea.
• It came out of the ‘Heritage Foundation’ in response to the failed Clinton health care effort.
• It was pioneered in Massachusetts under Republican Governor (and later presidential candidate) Mitt Romney.
• The Massachusetts program has been a success.
• The federal program has also been a success, in that it has substantially reduced the approximately $16 million people who had no health insurance before its enactment.
• Prior to the enactment of the Affordable Care Act, we (the taxpayers) already paid for the health care of the uninsured when they showed up at hospital emergency rooms with ailments that could have and should have been treated much sooner.
• Early estimates from the non-partisan Congressional Budget Office are that repealing the individual mandate would reintroduce about $13 million Americans to the rolls of the uninsured.
• Prior to the enactment of the Affordable Care Act, unaffordable hospital bills was the leading cause of personal bankruptcy in the United States.

Now Republicans have been telling us that they ‘only’ want to repeal the individual mandate. The more popular parts of the Affordable Care Act – like the prohibition on preventing those with pre-existing conditions from getting insurance – those they want to keep.

That’s a little bit like saying that they ‘only’ want to take the engine out of a car in order to save gas mileage.

Why is the Individual Mandate so Important?

A question that many people don’t know the answer to is, why is the individual mandate so important. And the short answer is that it requires younger and healthier people to buy insurance now so as to spread the risk around the entire population. It’s also the reason that the health insurance industry was willing to sign on to the Affordable Care Act, instead of standing in implacable opposition to any kind of universal health care package, as had been proposed by the Clinton administration, for example.

If you repeal the individual mandate, what will happen is that young and healthy people won’t buy health insurance, which means that only the middle class, middle-aged, old and sick people will contribute to health insurance. That would cause the rates to rise to such a degree that many of the elderly, and those with significant health challenges, would not longer be able to afford insurance.

It would literally kill people who don’t need to die.

What About those Rising Insurance Rates?

Republicans like Donald Trump keep assuring us that Obamacare is ‘imploding.’ But that is not true.  For sure, health care costs (and the insurance to cover them) continue to rise. But that is a problem separate and apart from the problem of getting people insured.  And it’s a tough nut to crack.

The Commonwealth of Massachusetts has made, and continues to make some efforts, to bring down health care costs. (Other states have probably also faced up to the challenge, but I’m mostly aware of the efforts here in Massachusetts.)  In 2012, the Commonwealth enacted Chapter 224, An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation. That Act introduced the concept of an ‘Accountable Care Organization’ (a vertical organization intended to improve coordination of care), and tried to find outlier hospitals, whose costs were out of line with other hospitals, to encourage them to reduce their costs. In particular, the bill requires health care entities that exceed a ‘cost growth benchmark’ to file and implement performance improvement plans, starting in 2015.

After several years of operation, the verdict is not in yet, but suffice it to say that much more needs to be done to bring costs down. Part of what is keeping costs up is the high prices charged for pharmaceuticals and by medical device makers.

But that’s a story for another day.

What’s the Hypocrisy Here?

The hypocrisy here is the notion that the desire to repeal the Affordable Care Act is about anything other than undermining President Obama’s legacy.

That’s what opposition to the Affordable Care Act has always been about.  I mean, consider:

• Obama deliberately began with a bi-partisan proposal, using as the model for the Affordable Care Act the law that had been passed in Massachusetts.[2]
• Obama went out of his way to solicit input from Republican Congressmen.
• Not a single Republican was willing to lend him a vote, because they were all so focused on making sure that he would be a ‘one-term’ President.
• Because they knew he would veto a repeal, the Republicans voted to repeal the ACA something like 56 times.
• Obama is no longer in office. His legacy is what it is, and repealing the ACA now will not change his legacy.
• And yet, our Republican friends in Congress feel duty-bound to continue on their ill-fated quest because that’s what they told their voters they would do back when he was still President.

Sheesh.  Is this a federal Congress, or a Second Grade Class?

[1] Yes, there is technically still a conference committee that the Republicans can convene, but they’re smelling and tasting their victory now. Finally something for their ‘base’ (who will get fucked but won’t know it) and their corporate overlords.

[2] When enacted in 2006, Massachusetts had a Republican Governor (Romney) and a substantially Democratic legislature. The result was a classic bipartisan effort.