Health Care

Mike Pence Shows the GOP's New Obamacare Strategy: Pretend It's Already Gone

Pence claims Obamacare was a "disaster" that Americans "remember." It's still very much on the books.

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Having failed to repeal and replace Obamacare, the Trump administration appears to have settled on a different plan: pretend it's already gone.

During last night's vice presidential debate, Republican incumbent Mike Pence responded to the charge that the administration was "trying to get rid of the Affordable Care Act, which means that you will lose protections if you have preexisting conditions," by saying that he hoped he would have the chance to talk about health care, "because Obamacare was a disaster, and the American people remember it well." 

The choice of words is telling. Obamacare was a disaster. Americans remember it well. Without explicitly saying that the health law has been repealed, Pence was speaking as if Obamacare was already gone. 

That is far from true. Although Obamacare has been altered in various ways over the years by the Supreme Court, Congress, and the executive branch, the law's major components remain. The Medicaid expansion, which accounts for approximately half the cost of the law, has grown as more states have adopted it. The subsidies and regulations governing individual market health insurance remain alive. Many of the taxes and fees imposed by the law are still on the books. The "disaster" Pence spoke of in the past tense is a present reality. 

The implication that it has been consigned to history was probably not an accident. For years, President Donald Trump has spoken of Obamacare as something that exists mainly in the past rather than a law that remains on the books. As early as 2017—following the passage of the Tax Cuts and Jobs Act, which set the health law's individual mandate tax penalty to zero—Trump claimed to have "essentially repealed Obamacare." During the first presidential debate, Trump responded to a question about his nonexistent but oft-promised plan to replace the law by saying, "I got rid of the individual mandate, which was a big chunk of Obamacare."

Even this statement is not entirely accurate: Although the mandate was widely viewed as an important component of the health law at passage, it turned out to have relatively limited effects, undercutting Trump's claim that it was a "big chunk" of the law. And although it is true that the 2017 tax bill set the mandate's tax penalty to zero, the requirement remains technically on the books as a toothless requirement. Indeed, the fact that the mandate remains without a penalty is the basis for the lawsuit the administration is currently backing against the law. 

Trump and congressional Republicans spent much of 2017 attempting to repeal Obamacare; that effort ended in failure. The current lawsuit challenging Obamacare, led by red-state attorneys general and supported by the White House, is based on dubious legal reasoning that many conservative and libertarian legal scholars—including those who supported previous legal challenges to the law—do not accept. Even if Amy Coney Barret is confirmed to the Supreme Court, it is unlikely that the challenge will succeed in wiping out the entire law

Pence's dodge is hardly a surprise. As governor of Indiana, he claimed to oppose Obamacare, then presided over a federally funded Medicaid expansion under the Affordable Care Act. He insisted this enactment of a central component of Obamacare was actually a market-based plan to reject it. 

Still, his rhetoric is revealing. Republicans spent the better part of a decade running against Obamacare, but the party never united around a coherent plan on how to repeal it or what to do next if they did. With no consensus on how to talk about the law, many GOP lawmakers have simply gone silent about it instead, avoiding the topic of what was once the party's top domestic policy priority. 

The GOP's avoidance represents a near-total failure of both policy reform and political imagination. But as a rhetorical strategy in the absence of any clear plan, it makes a certain amount of sense: What easier way to avoid the topic than to pretend it is merely an unpleasant memory, long in the past?

NEXT: Trump Threatens To Drop Out of Virtual Debate

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  1. I remember Obamacare as mandatory participation.

    If that is gone, Obamacare is gone.

    The rest is just a new variation of fucked up Federal interference in Medical Care.

    1. But the increased premiums and deductibles are still with us.

      1. Yes the misery lives on as does the the loss of freedom to buy the coverage you choose and are only allowed to buy the coverage mandated by the law. The law bought and paid for by the insurance lobby. Nothing more profitable than forcing people to buy coverage they don’t need, like older people needing to buy maternity care, fertility services, pediatric care, pediatric dental care long after child bearing years and after their children are grown and on their own.

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        2. Trumps plan to let all insurance companies sell any product in any state has been stifled by the States and the courts. Some progress in pushing “association” plans across State lines has been made.

    2. Part of the ACA was the mandatory free shit portion:
      providers must include no cost to the participant ‘well care’ in every single plan. It is the reason why there are no longer any affordable plans for those who just need catastrophic coverage.

      I just went through the process of picking a plan for my company. In 2007, I could insure my family of 4 for less than $300 a month with $10k deductible. Now the cheapest plan with the highest deductible will run $1000.

      Then there is the giant bullshit lie about pre-existing conditions, which providers were already required to cover as long as coverage didn’t lapse.

      1. Before 2014 I couldn’t find a plan with a deductible over $4k. That was considered “high deductible.” Now that’s considered low. My “catastrophic” plan, which included a yearly checkup, had a deductible of $2700. My premium was $80/mo. That got canceled and for an Obamacare plan with a $2500 deductible, it would be $240/mo. Thanks, Obama.

        1. And with a private plan you can’t use Health Savings Account unless you’re on a high-deductible plan.

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      2. Absolutely, I was one of the 5.5 million that had my affordable plan for my family cancelled by Obamacare. Now pay about $3k per year more for absolutely nothing.

    3. For some of us it was, and still is, mandatory participation, in the sense that it was/is the only game in town. If you were retired and not old enough for Medicare, you might have had your private plan cancelled because it didn’t qualify for grandfathering. Then you were forced to enroll in a compliant plan, whether or not you used the exchange. And thus you were stuck with paying for services you would never need and dramatically increased premiums for lesser coverage. Yes, I could (eventually) have legally gone without insurance, so technically it wasn’t mandatory, but for someone in their 60’s that isn’t a realistic option.

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  2. John McCain, Lisa Murkowski, and Susan Collins.

    A butthurt tool with personal animus toward the President, and – for all intents and purposes – two Democrats.

    That is why Obamacare is still on the books.

    1. Bullshit. The GOP never offered a coherent, comprehensive alternative. It was just a great bit here, and a great bit there. Yeah, Obamacare sucks, but so does the GOP’s failure here.

      1. “The GOP never offered a coherent, comprehensive alternative.”

        Apparently Reason used to be a libertarian website.

      2. A comprehensive alternative is agreement with democrats that this is the government’s business. I just want them out. My freedom to buy what I want/need is what I want, no government involvement is wanted nor welcome.

        1. I just want them out. My freedom to buy what I want/need is what I want, no government involvement is wanted nor welcome.

          Jeezus H Freaking Christ. Government has been involved in distorting the health care market since 1939 when employers began receiving subsidies for offering employer healthcare. Denying reality for one’s entire lifetime is the reason R’s and that stupid-wing of L’s are completely and always irrelevant. Instead – it is ALWAYS about pretending that everything before the most recent change is ‘the free market’ or ‘capitalism’ or ‘my freedom’ or whatever you want to praise – and only the most recent change is ‘evil incarnate’ or ‘preparatory to either the invasion of Poland and/or gulags’

          1. “Jeezus H Freaking Christ. Government has been involved in distorting the health care market since 1939 when employers began receiving subsidies for offering employer healthcare.”

            Jeezus H fucking christ, your stupid again ate your cite.
            Sorry to inform you that, post WWII, wage controls meant that providing ‘free’ health care was a method by which a company could bypass government controls, and I’m sure such facts are amazing to a fucking lefty ignoramus like you.
            As a cowardly piece of lefty shit, please jam your PANIC flag up your ass, stick first, and sit on it.

        2. Did someone force you to buy something?

  3. >>Republicans spent the better part of a decade running against Obamacare, but the party never united around a coherent plan on how to repeal it or what to do next if they did.

    T had zero to do with this.

    1. But NeverTrumper McCain certainly did.

  4. The rest of your article fell off. You know, the part where you condemn a government take-over of healthcare such as Obamacare. Without that part, it almost sounds as if you’re merely criticizing Trump for pretending Obamacare is gone rather than explaining why Obamacare should indeed be gone.

  5. The only chance was in 2017-2019. There were several RINOs who opted out of getting rid of the ACA during that time. So they hamstrung it instead. But you want Republicans to pretend to replace it? Why on earth would we do that? Let Harris-Biden fuck it up.

  6. Trump didn’t fail to repeal Obamacare. The entire republican party failed. They failed because they had no ideological rebuttal to Obamacare. They lost all will to defend market forces, freedom of choice and the engine of innovation that made the US great. Instead they attempted milquetoast reforms and renovations that implicitly conceded the federal government’s role managing our life cradle to grave.

    I left the GOP in 2012 when it was clear that the Republican Party was going to cram Romney down our throats, no matter what the cost. I wrote a long, likely ignored letter to the National Review as I canceled my account with them, and never looked back.

    The whole reason the GOP rebounded in 2010 was a unified, ideological rejection of Obamacare. The Tea Party was the last conservative attempt to hold the line against the government managing our every decision. And the GOP fundamentally rejected the Tea Party by pushing Romney- the one guy who couldn’t credibly run against Obamacare because he endorsed the same plan in his own state.

    I don’t like Trump, and I hate the left. But I have a deep loathing in my heart for the Grifters in the GOP who have slowly discarded every principle for rhetoric. I can still count on them to be useful for tax cuts or some other basic items, but it is clear that above all, they are no longer guided by the ideologies that Reagan professed.

    Living in California, I have seen how Republicans will sell out their ability to meaningfully defend freedom against the left in return for a couple “safe” seats in the state legislature. The Never Trump revolt is that same impetus writ large. The Lincoln Project is a perfect example of “Republicans” who are taking billions of Lefty dollars to keep their offices open while GOP power goes down burning.

    I’m sorry to all the Republicans who post here. I hope Trump somehow pulls out a win this year, but he cannot do it alone and the GOP has done nothing to help him.

    1. “I don’t like Trump, and I hate the left. But I have a deep loathing in my heart for the Grifters in the GOP who have slowly discarded every principle for rhetoric. I can still count on them to be useful for tax cuts or some other basic items, but it is clear that above all, they are no longer guided by the ideologies that Reagan professed.”

      How many Republicans voters are so principled? How many would be open to the idea of a free market for healthcare? How many would be willing to forego their entitlement to social security and medicare benefits?

      1. “How many Republicans voters are so principled? ”

        20 years ago, pretty principled. But the problem with principles is that if you don’t stick by them and defend them, your voters will throw them away. When Bush II signed tariffs on steel, GOP heads roundly criticized him, or at least excused it as a “Necessary evil” to placate a couple manufacturing cities in the east. And here we are today where the script has almost universally flipped.

        The funny thing is that it hasn’t been met from the other side by the Democrats. Bush II flipped the script on GOP resistance to federal Education funding via NCLB. He stopped resistance to medicare with medicare part D. Trump has given up on free trade. And the answer from the Democrats has been, “great but I’ll do that turned up to 11” and the republicans have nothing to counter with. How could they? They’ve already conceded the principles of the matter- they are just haggling over the price at this point- a point that the Democrats are always happy to outbid.

        1. Fair enough.

          I have never met a Republican in any of my circles that would forego Medicare and social security benefits in favor of a free market approach. To the contrary, most seem willing to fight to the death to defend their “entitlement” to such benefits.

          “I paid into the system, etc …”

      2. Social Security isn’t an entitlement, it’s a refund of money taken at gunpoint.

        1. Then how come you get back much more than you put in?

          1. ?? You never heard of interest?

          2. That is funny. I calculated what I have paid in over the years. Compare that with an average rate of return of 7% in the market. The government can send me a check right now.

            I have maxed out for decades. I will never get out what I put in.

            Some people will get out more than they put in. Not me.

          3. “Then how come you get back much more than you put in?”

            Wrong handle.
            Nor con_fuse; should be stoooopid.

    2. They lost all will to defend market forces, freedom of choice and the engine of innovation that made the US great.

      To do that, they’d have to repeal just about all medical insurance regulations. Republicans are not willing to do that, especially when the insurance companies and other sources of large campaign contributions are making more money than ever before.

      1. Yes, hence the “Grifters” label.

        You see, the Democrats are all for big government, so they have no problem taking those fat stacks of corporate dollars from Wall Street and Kaiser. But at least they are honest about it. The GOP is the opposite- they have been taking their money for years and years, while trying to sell the small government line. Of course they aren’t for small government. Their donors wouldn’t hear of it.

        1. >>I don’t like Trump, and I hate the left. But I have a deep loathing in my heart for the Grifters in the GOP

          I love T but the rest of this is spot on. The Graft Agents destroyed my faith.

    3. The Tea Party was the last conservative attempt to hold the line against the government managing our every decision.

      Yes indeedy. Keep your government hands off my Medicare!!

  7. “The current lawsuit challenging Obamacare, led by red-state attorneys general and supported by the White House, is based on dubious legal reasoning that many conservative and libertarian legal scholars—including those who supported previous legal challenges to the law—do not accept.”

    Then use the old arguments, and ask the Supreme Court to overturn its old decision and strike the whole thing down.

  8. And with no solid plan to nationalize America’s healthcare, Pence fails the libertarian litmus test.

  9. The entire premise of this article is ridiculous. I was one of the victims of the ACA. My private plan was cancelled because it didn’t qualify for grandfathering and I was forced into a compliant plan with a 40% increase in premiums with inferior coverage. For me the passage of Obamacare WAS a disaster and I REMEMBER it well. That’s how I interpreted Pence’s comments as soon as he made them, and anyone with half a brain would have taken them that way.

  10. Suderman staunch defense of ObamaCare demonstrates that he and Reason are no longer libertarian.

    1. Well, that’s been the running gag around here for a while.

      You know it’s bad when a Canadian is more libertarian than the publication.

    2. OK, I’ll bite, what makes Obamacare so bad?
      Last time I checked the average American used about $11k in medical costs – about the same as Germany. So that means, on average, you need to spend about $900 per person per month for insurance.
      How should that be paid?

      And of course we are talking averages. There are of course those that require much more, and those that require much less.

      I’m all for charging fat people, smokers, heavy drinkers, speeders proportionately more. Heck, we could do IQ tests and charge stupid people (like Trump supporters 🙂 ) more!

      So, if its not mandatory, the the per month charge goes up because healthy people will not buy in. However, there must be a penalty if you don’t. Say $100K surcharge if you get cancer and suddenly decide to join. Seems fair.

      So, what’s the better plan?

      Personally I would rather have a voucher system rather than employer paid. Employer would of course be taxed a bit more, but they wouldn’t have health care costs and they could offer real retirement. Maybe allow employers to offer bonus plans (or add-ons). Voucher system keeps insurance companies in the loop, but insurance companies know how to deal with doctors/hospitals etc.

      1. So, what’s the better plan?

        NO PLAN is the better plan.

        Get the government OUT of healthcare. Completely.

        Medicine should be a cutthroat industry with enormous competition and an endless push to be able to provide the best care for the best price so you can rack up a solid customer base.

      2. “…I’m all for charging fat people, smokers, heavy drinkers, speeders proportionately more. Heck, we could do IQ tests and charge stupid people (like Trump supporters ???? ) more!..”

        Triple the rates for lefty shits with TDS, and I’ll get mine for free.

  11. The Eagles ‘I’m Already Gone’ is in my head now.

    Thanks Peter.

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  13. When Obama was president, the Republicans put on show votes, “trying” to repeal obamacare. As soon as Trump got elected, the Republicans STOPPED voting to repeal it. That’s because they secretly want it.

    1. Correction…McCain and Murkowski wanted it and sunk the vote. The GOP didn’t have enough of a lead in the Senate to overcome that. Then the Dems took the House by ballot harvesting in 2018 and effectively killed any legislation.

  14. This is a ‘both sides’ issue. The Democrats illegally ‘deemed’ the law and put a bunch of terrible shit in it. The Republicans refused on multiple occasions to fully repeal it because they like controlling people’s healthcare from the federal level and feeding at the insurance companies’ trough. The Supreme Court even went out of their way to fail at their jobs in regard to Obamacare too.

    Obamacare is unamerican, unconstitutional, anti-freedom trash and it should have been, and still should be, destroyed with prejudice. All 3 branches of the Federal government had to circumvent the very document that gives them legitimacy to rule in order to shove this control down our throats.

    Fixing the US healthcare system can be remedied through eliminating the stranglehold the Doctor’s association and Universities have on regulatory capture and eliminating anything but catastrophic insurance from the markets.

  15. I can’t agree. Like others who have commented here, I lost a great affordable plan when the mandates took effect, and was never able to afford a replacement. I avoided other non-compliant plans because of the penalty. Without the penalty, I can buy a catastrophic coverage plan and otherwise pay cash.

    At Vanderbilt, I got a 66% discount for being a cash-pay patient. Repealing Obamacare would return health insurance back to the private market. Why is a replacement required? Are libertarians actually complaining that there isn’t another unwieldy plan to replace it?

    Without the penalty, the unconstitutional mandate is toothless. Without a solid majority it cannot be repealed, so why is that falling in Pence’s lap? Did you expect a comprehensive answer in two minutes? The entire health care system needs to be rebuilt. It’s not fair to expect a lengthy and thorough discussion in a debate under current debate rules. It’s a complex problem.

    I, like others, took Pence’s comment as a reference to the removal of the penalty, restoring individual choice. The plans sucked and were wildly expensive.

    It’s still on the books and ought not to be, but slamming Pence for a short statement about it having been a disaster is a pretty shaky foundation for the argument that Republicans pretend it’s no longer there.

  16. We are in too deep. Can’t back out.

  17. Never forget that every single Congressional Dem claimed in PPACA that they are authorized by the commerce clause to control our economic decisions.

    From PPACA:
    EFFECTS ON THE NATIONAL ECONOMY AND INTERSTATE
    COMMERCE.—The effects described in this paragraph are the following:
    (A) The requirement regulates activity that is commercial and economic in nature: economic and financial decisions about how and when health care is paid for, and when health insurance is purchased

    Judge Gladys Kessler (Mead v. Holder):
    For the foregoing reasons, the Court finds that Congress had a rational basis for its conclusion that the aggregate of individual decisions not to purchase health insurance substantially affects the national health insurance market. Consequently, Congress was acting within the bounds of its Commerce Clause power when it enacted § 1501

    Justice Ginsberg et al (NFIB):
    First, Congress has the power to regulate economic activities “that substantially affect interstate commerce.” Gonzales v. Raich, 545 U. S. 1, 17 (2005). This capacious power extends even to local activities that, viewed in the aggregate, have a substantial impact on interstate commerce. See ibid. See also Wickard, 317 U. S., at 125 (“[E]ven if appellee’s activity be local and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress if it exerts a substantial economic effect on interstate commerce.”

    (and)

    Given these far-reaching effects on interstate commerce, the decision to forgo insurance is hardly inconsequential or equivalent to “doing nothing,” ante, at 20; it is, instead, an economic decision Congress has the authority to address under the Commerce Clause.

  18. Con_fuse9 had a very reasonable response here. But I think what needs to happen I’m this country, is that we need to decide whether or not healthcare is a right or a privilege. We can just put a simple measure on the ballot saying “Is healthcare a right or a privilege.” If it’s decided that healthcare is a right, then we can move forward and either improve on ACA, or if it’s decided that healthcare is a privilege, then we can completely dismantle ACA and let life go on as it did before ACA. However, if you think all of us will keep the healthcare provided by some employers, you just might find the opposite and find that you no longer have coverage because your company may have found it more rewarding to use that money to pay investors dividends.

    I own my own company, so I’m pretty sure I’ll always have insurance until I decide to retire and close shop. But then I’ll become one of the many uninsured people. But I have to say, it is pretty disappointing to have seen my insurance rates more than double in the last 5 years or so. I’m in my late 50’s now, so my insurance company says it’s because I’m older now. The only dr I still see is my GP and that’s about it. I call bullshit on that, but I’m not sure if it’s so expensive for profit or because of ACA.

    I personally think that as a citizen of the USA all citizens have a right to healthcare, but I’m pretty sure there are a lot of us here who think the opposite.

    What’s your feeling?

    1. “…However, if you think all of us will keep the healthcare provided by some employers, you just might find the opposite and find that you no longer have coverage because your company may have found it more rewarding to use that money to pay investors dividends…”

      You’re full of shit.

      1. That’s a pretty logical and reasonable answer. Anything else?

    2. “I personally think that as a citizen of the USA all citizens have a right to healthcare, but I’m pretty sure there are a lot of us here who think the opposite.”

      I think I have a right to whatever you produce, assuming you produce anything other than bullshit.
      You’re still full of shit.

      1. Oh, this must be your second logical and reasonable answer. Second grade education?

    3. Healthcare is neither a right nor a privilege.

      It is not a box of cornflakes either.

      We keep going back and forth about it. Perhaps doing nothing is the best option.

  19. The Republican platform hasn’t been this flyblown since 1929, when dry killers shooting people in the back and confiscating their property because “light beer leads to harder drugs” was the new normal. Then the Crash and Depression became the new normal as money fled banks ahead of the confiscators. The Liberal Party wrote a repeal and legalize plank in 1930. The Dems copied it gratefully and God’s Own Prohibitionists spat on it. Voters then spat on God’s Own Prohibitionists for the next 20 years. That is evolution in action.

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