Land mines abound for Republicans in Obamacare replacement

Now that Republicans control of both houses of Congress as well as the presidency, many are expecting Obamacare to be repealed and replaced very soon.  Whether by simple majority vote, employing the Senate "nuclear option," or using the same budget reconciliation sleight-of-hand that Harry Reid so deftly used, the ability to undo the ACA is there for the Republicans' taking.

As the alternatives for a new act fly back and forth, the obvious trap for Republicans is crafting a piece of health legislation that is actually better, not merely different – wider coverage, easier access, more provider choices, lower costs, more provider accountability, less wasted mandated coverage (no maternity coverage for post-menopausal women, for example), no religious/moral/government mandate conflicts, etc.

The list of must-have items for a successful replacement plan is long.  Crafting a plan that satisfies all those requirements will be a monumental task, especially in a reasonable timeframe.

However, regardless of the details of the actual replacement plan, gaining widespread public acceptance and overcoming structural anti-Republican bias is going to be at least as big a challenge as crafting the legislation itself.

There are three essential public relations issues with the Republican alternative to Obamacare that are problematic, any one of which by itself could spell doom in terms of widespread public acceptance.  All three together mean disaster.

  1. Obamacare is President Obama's "signature domestic achievement," as they call it.  It's his crowning glory.  Supporters claim that it comes closer to providing universal health care than anything that has come before.  President Obama personally gets the credit for it.  His supporters and cheerleaders love this and do not want his so-called legacy jeopardized by having it dismantled.  To repeal it will leave millions without medical coverage in the immediate short term, and because of the potential administrative and logistical time lag before a replacement plan is in place, millions may fall through the cracks and be left without any workable, affordable coverage whatsoever.
  2. The liberal mainstream media are virulently anti-Republican and anti-Trump and are loath to run stories that cast either the president or Republicans in a good light.  These media outlets include not only the traditional liberal media like the broadcast networks; major papers like the New York Times, Washington Post and Boston Globe; and cable news like CNN, MSNBC, but also social media sources like Zuckerberg's Facebook, which has been exposed for downplaying conservative stories, and the supposedly "neutral" internet resources like Snopes, a "fact-finding" site which has been caught multiple times putting forth a liberally sympathetic version of the facts and being slow to change when the conservative-favoring side of the story proves to be true.  Any proposed Republican alternative to Obamacare, regardless of its actual merits, will be dismissed by the liberal mainstream media as unacceptable in order to preserve their pro-Obama narrative.  The liberal media are always going to highlight and key in on any aspect of a new Republican-backed plan that they deem inferior to the existing ACA, while ignoring any benefits or advantages.  No doubt, as soon as actual Republican-sponsored legislation is proposed, we'll see headlines like "Millions will lose coverage under GOP proposal," "Single women and minorities will pay more," "Insurance costs will decrease for rich with GOP plan."  That is a sure bet, as reliable as a Brady win in the playoffs.
  3. The Republican alternatives always seem to focus on tax credits as a way to help pay for health care insurance.  In order to receive tax credits, an individual or family must earn enough money such that offsetting the tax they owe is a relevant and attractive proposition.  The underlying, undeniable but rarely admitted liberal position is that Obamacare – which is essentially just affordable insurance that the government will largely pay for if the party can't afford to pay for it on his own – is a partway measure at best.  What the Democrats really want to do is to find a way to flat-out give health care away to everyone, regardless of tax status or income.  Democrats want single-payer (government-run) health care, not the private system involving for-profit insurance companies that we have now.

Any of these three – a threat to Obama's legacy; relentlessly inaccurate, biased reporting by the liberal mainstream media; or the perception that the Republicans are against the poor because their favored tax credit-based approach assumes employment and sufficient earnings – gives Democrat lawmakers more than enough ammunition for high-profile public grandstanding.

How do Republicans avoid their usual P.R. disaster?

First, they must craft a good bill, a legitimate improvement over the existing ACA.

Then, the Republicans need to learn a lesson they seem incapable of learning: they need to understand that the merits of the issue do not carry the day in the court of public opinion.  It's the ten-second sound bite that wins the attention of the casually attentive swing voter.  Democrats are very good at that – "tax cuts for the rich"; "Bush lied, people died"; "big pharmaceutical companies are ripping you off"; etc. – especially since the liberal media never hold the Democrats to account for the veracity of their statements.  Republicans have the challenge of not only crafting a ten-second sound bite that distills the essentials down into an easily memorable clip, but also being accurate and truthful, because the liberal media will not let them get away with the same fuzzy math they let slide for the Democrats.  Tall order, but it's about time the Republicans learned how to play this game.

Third, be unified.  They need to avoid the destructive public infighting that gives the liberal media the opportunity to say, "See?  Even the Republicans don't like it."  The Democrats are much better at standing unified on legislative issues than the Republicans are, and this works against the Republicans' P.R. interests.

Fourth, strike first and strike often.  Set the tone and terms of the public health care discussion.  Be proactive in speaking about why the new bill is a huge improvement, point out the current ACA's shortcomings and failures again and again, and keep the pressure on the Democrats about that.  Make the Democrats respond to you, not the other way around.

The actual ACA replacement bill is an interesting proposition, but even more interesting to political observers will be watching how the Republicans present and defend their bill, and how they deal with the inevitable negative reaction of the liberal media.