The ACA Was Not A “Republican” Proposal

As promised/threatened yesterday, my longer piece on why it’s both wrong and pernicious to argue that the ACA was based on a Republican proposal.

A couple additional points:

• Although I left the argument to my linked original piece, several people on Twitter have brought up John Chafee’s 1993 proposal as proof that the ACA had Republican origins (which Moore, to his credit, didn’t.)  To reiterate the obvious, this argument has two fatal flaws.  First of all, the Chafee proposal, which didn’t have a Medicaid expansion, is substantially worse than the ACA.  And even more importantly in this context, Chafee’s health care proposal was exactly as much a “Republican” proposal as Chafee’s proposed federal handgun ban.   The Republican offer to the uninsured in 1993 was identical to the one in 2014: “nothing.”
• It’s peripheral to my main point, but it’s also wrong to say that the ACA is a “pro-insurance-industry plan.”  The insurance industry, which spent several million dollars opposing it, was under no such illusions — it was doing just fine under the status quo ante.  The idea that the health insurance industry was going anywhere absent the ACA is bizarre, and while the ACA was more favorable to the health insurance industry than the politically impossible creation of a single-payer system would have been, it wasn’t more favorable than what existed in 2008.
• I understand that the “ACA was a Republican plan” line is, if anything, more common among ACA defenders than opponents.      (E.J. Dionne made it earlier in the week.)  But that the argument is well-intentioned either way doesn’t make it any less wrong and counterproductive.  Particularly with the constitutional challenge to the mandate having been settled, there’s nothing to be gained by a line of argument that both implicitly understates the progressive content of the ACA and explicitly gives Republicans credit they manifestly don’t deserve.  Whether the ACA is “liberal” in some absolute sense, in the context of American politics it clearly is.  We can discuss the merits and defects of the ACA without imagining a moderately progressive national Republican Party that has never existed, and we should.