The Republican opt-out strategy

The rollout of the Affordable Care Act has been a slow-motion disaster, but not for reasons that are making media headlines. Granted, the assumption was that the techies and the policy folks had several years to get the online, signature legislation up and running and, of course, glitch-free; that they didn't is at best puzzling.

The administration knew from the moment ACA was passed by Congress, absent the assent of a single Republican, that it was the driving mission of the conservatives to defund and repeal the health care law. Legal challenges were immediately crafted in red states, questioning the constitutionality of the law's mandate, challenges that were soon argued before the Supreme Court.

When the Supreme Court validated the efficacy of the law, it simultaneously opined that the expansion of Medicaid should be optional for the states.

What is astonishing is that for all of their criticism, for all of the Republican predictions of ACA's imminent failure, when asked what they would put in its place, they launch into chronic obfuscation. A Kabuki dance of evasion.

In a recent interview, Sarah Palin, who regards herself as the tip of the tea party spear, was asked to explain her alternative to Obamacare. Palin at first sidestepped the question, saying it's not just the grassroots tea party movement that wants to repeal ACA. When the correspondent pressed her again for a plan, Palin said, "The plan is to allow those things that had been proposed over many years to reform a health care system in America that certainly does need more help so that there's more competition, there's less tort reform threat, there's less trajectory of the cost increases. And those plans have been proposed over and over again. And what thwarts those plans? It's the far left. It's President Obama and his supporters who will not allow the Republicans to usher in free-market, patient-centered, doctor-patient relationship links to reform health care."

Seriously? That's it? Indeed, that's it. Ask any Republican to PowerPoint the GOP plan for health care reform and you will get a variation of Palincare. A study in vacuity.

And this plan is proffered knowing the following: A survey by the Commonwealth Fund, a research organization, as reported by the New York Times, found that "37 percent of American adults went without recommended care, did not see a doctor when sick or failed to fill prescriptions in the past year because of costs." And nearly a quarter of Americans could not pay medical bills or had serious problems paying them.

When Americans got sick they had to wait longer than people in comparable countries to get help. As well, tens of millions are uninsured and face each day fearful that the unthinkable will occur and they will fall into a financial abyss from which they cannot recover.

Republicans know America is desperate for comprehensive health care. How can they not? It is inexplicable that they will not acknowledge that ACA represents our best hope for drawing a circle of care and bringing all Americans in.

But ACA continues to be the focus of an orchestrated effort by conservatives to dismantle it in whatever way possible. An example is the cruel and arbitrary rejection of ACA's proposed expansion of Medicaid (means-tested health care for children, the very poor and the disabled, managed by the states, with 1,128 health centers across the U.S. aimed at the underserved and uninsured).

Some 25 red states have rejected any form of expansion, the offered reason, disingenuous in the extreme, being that it will be too costly. Putting the lie to this weak rationale is the fact that the federal government will pay 100 percent of the expansion in 2014 through 2016, with an incremental drop each year until 2019 when it will pay 93 percent and then 90 percent thereafter. It is also a fact that over 50 percent of all those who would qualify for expanded Medicaid live in states whose governors and legislatures have opted out of the ACA program.

For the Republicans, once again, ideology trumps a moral imperative. Consider that there are those among us who need health care but are not poor enough to qualify for Medicaid under the current, unexpanded guidelines. They also cannot afford to buy the health care offered by ACA. These people, some 5 million, will needlessly drop through a doughnut hole where they will once again be faced with going bare. For them, the fear and angst of the status quo will not end, for reasons that are at best mean-spirited.

Ultimately, it's inexplicable and finally unconscionable. But then it is demonstrably true that the Republicans have opted out of governing entirely, choosing instead to become the party that says, simply and repeatedly, "no," putting party and ideology before the people.

Chris Honoré lives in Ashland.

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