Senator Rand Paul (R-KY) sent a letter to Senate Majority Leader Mitch McConnell (R-KY) outlining his expectations for an Obamacare repeal bill. While Senator Paul's intentions genuinely seem to be good, he's doing more to undermine the conservative position on Obamacare repeal than he realizes.
The letter focuses almost entirely on the deficit spending components of the GOP's repeal proposal. While I agree in principle with Paul's view that government spending should be reigned in, deficit spending in and of itself is not a problem as Paul portrays it. The reason conservatives are generally opposed to deficit spending is the possible eventuality that taxes will ultimately have to be increased so that the government can pay back its debts. As long as the government eventually manages to pay back its loans and cut spending and taxes don't get raised, deficit spending isn't a matter of great concern. However, Rand doesn't realize this. He's too caught up in the Ayn Rand-esque ideological libertarian dogma, one of the core principles of which is that government spending is an abomination and must be reigned in at all costs. This ideological battle for libertarian purism has no practical benefits and may result in every word of Obamacare being kept in place.
While the letter discusses heavily the insurance company bailouts and tax credits, a mere three generic, unenthusiastic lines are devoted to discussing the most crucial component of Obamacare that must be repealed - the insurance regulations. These regulations' unconstitutional interference in the private sector is what has driven up premiums for millions of Americans, making health insurance unaffordable for many families. These rising premiums have helped Republicans to score massive wins across the country, including in many solidly Democratic states, over the past eight years. Americans don't rush to the polls to vote for Republicans because they're up at night fretting over how much money America is borrowing from other countries. They care about the cost of health insurance, how they're going to pay the bills, and taxes. And they've spent the past eight years giving the right a mandate to bring their premiums down at the polls. This is why Senators Ted Cruz (R-TX), Ron Johnson (R-WI) and Mike Lee (R-UT) have chosen to focus their discussion of Obamacare repeal on the costly insurance regulations. Repealing these will actually improve the lives of millions of Americans, making health insurance cheaper and leading to rewards for the GOP in the 2018 midterms and beyond. Rand Paul's more principled, ideological approach of focusing on the deficit alone will not solve the problem of rising premiums and it surely won't lead to more electoral victories for the Republican Party.
Would a perfect repeal bill nix the subsidies and tax credits? Of course. But there's simply no way we're going to get a perfect bill through the Senate with a slim 52-member Republican majority and a caucus full of liberal Republicans, many of whom come from states that have already adopted Obamacare's Medicaid expansion. Senators Dean Heller (R-NV) and Susan Collins (R-ME) already seem unwilling to vote for almost any version of the repeal bill. Several other moderate senators have signaled they won't vote for a bill that doesn't include the tax credits, and even with these credits their support is shaky. As of right now, there seems to be an ever so narrow path to passing a decent bill that repeals the most crucial elements of Obamacare in the Senate. It involves the conservative wing of the Senate using its leverage to sway reluctant leadership to repeal all of the ACA's insurance regulations. Collins and Heller would probably defect, but with the subsidies, tax credits and delayed Medicaid rollback left untouched, leadership should be able to barely sure up the support of every other Republican senator. The bill would barely squeak its way to 50 votes and Vice President Mike Pence would break the tie.
But unfortunately, Rand Paul is crushing this already slim path to repealing Obamacare over a silly obsession with the deficit spending. By stubbornly refusing to negotiate on any bill that includes subsidies, Paul is choosing to fight a losing battle. In effect, he's giving up his political capital by making himself a hard "no" on this bill no matter what concessions leadership is willing to make (of course, short of a completely deficit-neutral bill). Should Paul choose to stick with this dogmatic, ideological approach to the healthcare negotiation, he may ironically be the one man who completely destroys the chance that any sort of Obamacare repeal is passed in the foreseeable future. Rand's libertarian purism may be what saves Planned Parenthood funding, keeps Obamacare's regulations and taxes in place, and allows premiums to continue to steadily rise year after year. Even worse, Rand's purism may force Republicans to strike a deal with Democrats to save Obamacare, which would, quite poetically, involve an obscene amount of subsidies and bailouts.
What a cruel twist of fate. The savior of Obamacare won't come from the #TheResistance keyboard warriors who spend their days tweeting and spamming the voicemail of Republican Congressmen in other states. It won't come from a group of screaming hippies wearing pussyhats and holding signs that read "Please don't kill me." It won't even come from any Democrat in the House or the Senate. Rand Paul, a hardcore libertarian, may be the one man who can save Barack Obama's only major legislative accomplishment.