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Public attitude shift on health care challenges N.Y. Republicans

Public attitude shift on health care challenges N.Y. Republicans

It did seem to be enough for Faso
Public attitude shift on health care challenges N.Y. Republicans
House Speaker Paul Ryan speaks at a news conference about plans to continue an effort to repeal the Affordable Care Act.
Photographer: Doug Mills/The New York Times

When it’s halftime in a football game and your team is unexpectedly behind, the mid-game break seems as good a time as any to reassess your strategy.

That is an apt metaphor for where Republicans appear to be after failing in their first real opportunity to consummate a seven-year quest to repeal “Obamacare."

Twenty-four million thrown off insurance and a 17 percent public approval level for House Speaker Paul Ryan’s alternative to the Affordable Care Act (ACA) obviously didn’t serve as enough inspiration for the team.

Surprisingly, it did seem to be enough for a local veteran player. Congressman John Faso (R-Kinderhook) provided the critical vote that moved Ryan’s bill out of committee. Then he stated his overall support once an amendment was attached to require New York state taxpayers to pick up the 13 percent of Medicaid costs currently covered by upstate county taxpayers.

Even Republican State Senate Majority Leader John Flanagan publicly termed that shift of responsibility a shell game.

It fell to the local political novice, second-term Congresswoman Elise Stefanik (R-Glens Falls), to assess the game more astutely by repeatedly stating her intention to examine the legislation for its effects — good or bad — on her constituents, withholding a decision until “the game” stabilized.

It never did.

REPEAL/REPLACE

Clearly — and remarkably given its seven-year gestation — Ryan’s American Health Care Act was a hastily conceived plan that would have hurt New Yorkers grievously.

Regardless of how resolution of this issue proceeds in the coming months (or years), the substance of the speaker’s plan is not likely to change largely because his and his party’s declared ideology denies government a prominent role in securing health care for the general public.  

Mechanically, it would still kick out the tax and financial underpinnings of the ACA and then try to stabilize a roiled health care market through regulation. The key, however, would still require the political coercion of at least eight Senate Democrats up for re-election in 2018 to provide the 60-vote threshold needed to complete whatever overhaul ultimately emerges.

DISADVANTAGE, NEW YORK

Already, only 91 cents of every dollar New Yorkers pay to the federal treasury comes back to the state. That quotient would only be worsened if this state were to lose a significant portion of the $27 billion in Medicaid funds it received from Washington in 2015 that, together with New York’s insurance exchange, has reduced this state’s level of uninsured to fewer than 5 percent.  

The cost would be human as well since many — a million or more — would either lose coverage entirely or have their quality of coverage lessened, an eventuality that even the speaker has publicly acknowledged.  

Undoubtedly, there would be pressure on the state from its citizens to make up as much of that shortfall as possible on its own—placing upward stress on already high state tax rates.   

FALSE APPEAL

Ideologically conservative Republicans target “mandates” — the ACA requirement that everyone whether young or old, healthy or sick, have insurance through one means or another — as a fundamental assault on individual liberty.

This is a thoroughly false appeal.

Just as with automobile insurance — which incidentally is mandatory — the need for health insurance cannot be predicted. Whether in the automobile market where safer drivers also cover the more accident-prone or in the health care market where those in less need of medical intervention also cover those in need of more, the bargain in the mandates is that when your position become less advantageous you will not be abandoned or bankrupted as a result.

Since under a 1986 law no one can be denied necessary medical services for inability to pay, those that use their “freedom of choice” to underinsure or avoid insuring themselves essentially become freeloaders. Their parasitic freedom is underwritten by the more responsible members of society through higher costs applied to the latters’ care or by general taxation.  

ATTITUDE ADJUSTMENT

Public attitudes also have shifted significantly even though Republican orthodoxy hasn’t.  

There are faults in the ACA, but it is not the imploding disaster Republicans claim.  Objective analyses show mixed results.  The public message has become, “Don’t repeal it; fix it!”  

However, wisdom unencumbered by ideological imperative seems to be in short supply here.  It is Republicans--hamstrung by their ridiculous “Hastert Rule” dictating that majorities for legislation come entirely from Republican votes—that are preventing a bi-partisan majority from acting in accord with the public’s wishes.

New York’s nine Republican members of Congress have the capacity to help that majority to emerge and, in the bargain, preserve hard won health care security for their constituents as well.

The question is:  Will they?  

John Figliozzi is a regular contributor to the Sunday Opinion section.

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