By David Thornton
After supporting earlier versions, Rep. Billy Long (R-Mo.) has become the latest conservative to jump ship and oppose the Republican effort to scuttle Obamacare.
Long represents Missouri’s seventh congressional district, a deep red district in the southwest corner of the state that includes Branson and Springfield. The district has been represented by a Republican since 1961. Voters there supported Donald Trump by a 70-25 percent margin over Hillary Clinton. Trump’s margin there was larger than that of any Republican presidential candidate this century. Long won both the 2016 primary and general election with more than 60 percent of the vote.
The conservative nature of Long’s district makes it all the more surprising that he would not be on board the Obamacare replacement effort. According to a statement by Long in Politico, it came down to how the Republican bill dealt with pre-existing conditions.
“I have always stated that one of the few good things about Obamacare is that people with pre-existing conditions would be covered,” Long said. “The MacArthur amendment strips away any guarantee that pre-existing conditions would be covered and affordable.”
The MacArthur amendment is a compromise reached between Rep. Tom MacArthur (R-N.J.) and Freedom Caucus Chairman Mark Meadows (R-N.C.). The amendment would allow states to seek waivers for several provisions of Obamacare such as benefits that are required to be covered under the law and the ban on allowing companies to charge more based on a person’s health history.
MacArthur told CNN that the plan would protect people with pre-existing conditions while giving states more flexibility. “We need to protect the most vulnerable people in the current plan. These are people with pre-existing conditions,” he said. “We want to make sure they are protected. Secondly, we have to give the states flexibility to bring premiums down for everyone else.”
Long’s opposition to the amendment underscores the difficulty that Republican leaders have in finding a balance between moderate and conservative viewpoints on healthcare. Like Long, even many Republican voters who have favor repeal of Obamacare find parts of the law attractive.
One of the most popular aspects of the health law is the provision that requires insurance companies to cover people with pre-existing conditions. A CNN/ORC poll from March found that 87 percent of voters favor “maintaining the protections offered to people with pre-existing conditions under Obamacare.” The numbers are unchanged across the political spectrum with 87 percent of Republicans and 85 percent of conservatives agreeing with the statement.
Such overwhelming opposition explains why so many Republican congressmen are reluctant to get on board with conservative plans to eliminate the requirement to cover pre-existing conditions. With a lifetime American Conservative Union rating of 91 percent, Long is no moderate or squish. A member of the House of Representatives since 2011, Long has undoubtedly learned to listen to constituents and is most likely hearing from many of them that they want pre-existing conditions covered.
The economic difficulty is that there is no free lunch. If pre-existing conditions are covered, many people won’t buy health insurance until they get sick. If people only buy insurance when they are sick, the cost of coverage goes up.
The Republican difficulty is that the free market position held by many conservatives is that the government should not mandate that insurance companies cover pre-existing conditions. This conflicts with the popular opinion of voters that people with pre-existing conditions should not be denied health insurance. The conflict has caused a schism in the party between those, often from safe Republican districts, who favor free market policies and those who are listening to the majority of voters.
There is also a time factor. Republicans lack the 60-vote majority in the Senate to avoid a filibuster so they are relying on the budget reconciliation process to pass their health care reform. If they cannot get agreement on health care, the budget reconciliation opportunity will vanish for another year.
The conundrum is similar to the one that Democrats faced in 2010 when they passed the Affordable Care Act. Poll after poll showed that voters opposed the Democrat version of health care reform. A CNN/Opinion Research poll taken just before the bill’s passage found that 59 percent opposed Obamacare. Democrats forged ahead against public opinion and paid for their arrogance with the loss of the House, the Senate and ultimately the White House.
The lesson is one that Republicans should take to heart. An election victory is not a blank check from the voters. If Republicans force an unpopular policy on the country, they may well find themselves punished by voters in 2018 and beyond. The defection of conservatives like Billy Long may be a bellwether of a rising public anger that could endanger the Republican majority.