Railroading the health care law - Kansas City Star

President Barack Obama will talk about the economy when he visits Warrensburg, Mo., tomorrow — job prospects, education, home ownership, that sort of thing.

But it’s possible he’ll also mention the never-ending slap fight over the Affordable Care Act, the health care reform law rumbling toward almost-full implementation at the end of the year.

He can hardly ignore it. Over the last five years, Republicans have spent far more time criticizing Obamacare than any other single subject. Last week, they were at it again, urging a delay in the law’s requirement that almost everyone buy health insurance.

GOP lawmakers are banking on the poll-confirmed unpopularity of the ACA. If implementation turns out to be a train wreck, as Republicans and even some Democrats have predicted, they believe the law may collapse of its own weight.

But the GOP has been far less specific on what alternative health care reforms it would support. Maybe private insurance tax credits, maybe high-risk insurance pools for those already sick, maybe lawsuit reform, maybe something else.

Or, maybe, nothing at all. While publicly endorsing “common sense” reforms, most Republican office holders would trade the Obamacare train wreck for maintaining the health care status quo, with high costs, poor outcomes, insurance confusion and dramatically uneven access to medical care.

Why does the GOP lack an alternative to Obamacare?

Partly because Obamacare is the Republican alternative, or was, 20 years ago. Republicans were the first to propose the individual mandate as a response to the Clinton-era drive for national health insurance. That’s why the mandate was embedded in Mitt Romney’s Massachusetts plan. That’s why four local GOP senators co-sponsored a 1993 bill that included an individual mandate.

Today, Republicans have abandoned their mandate, offering a sketchy replacement blueprint instead. Call it a just-say-no approach.

But it’s possible some voters oppose Obamacare because it doesn’t go far enough. And if the new health care law collapses, they may insist on another look at Clinton-style, single-payer national health insurance. Especially if, ahem, a well-known Clinton is a part of the federal government.

Far-fetched? Four years ago, 57 percent of Americans opposed same-sex marriage. Today, a majority supports the idea. Public opinion can change pretty quickly.

Republicans may succeed in driving Obamacare off the rails. If they do, they may need to quickly face a bigger locomotive on the other track.