One challenge for Republicans running in 2014 is how to handle the fact that millions of people are gaining coverage under the Affordable Care Act. Obamacare remains unpopular (although so does repeal) and Republican candidates hope to ride the anti-Obamacare wave to victory, particularly in a place like Obama-hating Arkansas. But as the law is implemented and people get signed up, Republicans face the awkward fact of the law’s enrollment successes and the fact that ending the ACA means ending people’s coverage. 

One strategy, as Dylan Scott of Talking Points Memo illustrates, is to deny the law’s enrollment successes altogether. To be clear, there are important open questions: How many people have paid a premium (if enrollees never pay their first month’s premium, they’ll never get coverage)? How many of those who’ve gained coverage were previously insured? But the law has surpassed enrollment projections and more and more data is coming in that the uninsurance rate is falling. But Obamacare was destined to be a train wreck! So we’re left with stuff like “Debunking Obamacare’s 7 million [now 8] Enrollees ‘Success’ Story.”

Rep. Tom Cotton still has one foot in the denial phase. At a townhall event focused on health care in Waldron last Monday (no media was present, but someone in attendance sent the Arkansas Blog an audio recording of the meeting — see here for a previous post on the event), Cotton told his audience that somewhere between 4.5 and 6 million had actually enrolled, and “that’s also projected to decline over time.”


The real story, says Cotton, is the plans that were cancelled because of Obamacare’s coverage mandates. “The law was designed to cancel those plans force people to go into the exchanges,” Cotton said. Remember, Republicans like to claim that those cancellations could lead to Obamacare reducing the number of insured people on neteven though that is not what has happened. Here’s Cotton: 

What was the point of Obamacare? The whole point of it was to get affordable, quality health care access for everyone. The President said in his speech in 2009 that there were over 30 million Americans without insurance, and that’s a bad thing. We need to get those people insurance. The Congressional Budget Office said that after Obamacare there are going to be 31 million Americans without insurance. In some ways this has been nothing but a churn operation designed to grow the power of the federal government, take more money away from taxpayers, and line the pockets of insurance companies and take more power and control over your lives away from you as families or employees or small businessmen or small businesswomen, and that may be the most disappointing thing of all.

Notice the sleight of hand there as Cotton talks about the raw number of uninsured people rather than the rate of uninsurance in the population (if you’re scoring at home, the population did not stop growing in 2009). 


So, nothing to see here, people aren’t gaining coverage! Repeal the Obamacare monstrosity! Oh, and what about the 150,000 (and counting) Arkansans who have gained coverage through the private option, funded by Obamacare? Cotton doesn’t have a position on that

Cotton also trotted out the familiar job-killer line. The Congressional Budget Office found that more than 2 million people would choose to leave the workforce because they now had access to affordable health care outside of their job. Here’s Cotton’s spin: 


Obamacare actually has a pretty severe impact on jobs. The Congressional budget office in another report has said Obamacare will probably cost up to 2.5 million full time equivalent jobs by 2025, over the next ten years. That’s a lot of jobs, especially when you just barely have gotten back to the number full time equivalent jobs in our economy today as we had before the financial collapse. …

You…have the phenomenon of people essentially being paid not to work. The Congressional Budget Office has said that as well, that they’re going to be choosing not to work and that’s not good for our economy. It’s not good for our country. It’s not good for people who are working that they’re going to have to be pulling the load for people who just choose not to work all day. 

Cotton says he wants to repeal Obamacare but tempers expectations. We’ve come a long way from the heady shutdown days. 

We have to be measured in our expectations about what we can accomplish in terms of repealing Obamacare as long as the man in the White House is named Barack Obama. It’s his namesake legislation, after all. That may have to wait until 2017. I think it’s going to have to occur because the law is so fundamentally flawed. 

Cotton, like Republicans across the country, recognizes that only being against Obamacare ins’t enough. They won’t just repeal, they’ll replace, with something something something. 

A constituent asked Cotton, “What is the Republican solution to the health care problem our country faces?” Here’s Cotton’s long response, which I’ve copied in full below, after the jump. This is an important question, and it’s worth listening to Cotton’s answer. He hits on familiar Republican talking points on health care. Some of his suggestions are less vague than others. Without getting in to the costs or feasibility or issues inherent in any of these ideas — it’s worth point out that whatever their merits, these are not proposals that would come anywhere close to covering the number of people that Obamacare does. There is certainly nothing here that would offer coverage to the 150,000 Arkansans who would stand to lose their private option coverage if Obamacare was repealed. That’s fine — Cotton’s position may simply be that the safety net for health care should be less robust. But as enrollment increases, this is the reality that Cotton will face: as he campaigns in Arkansas, his position — repealing Obamacare — means taking people’s Obamacare coverage away. 

Here’s Cotton:


So, you’ve heard me say that I want to replace and repeal Obamacare because we had a real problem that led to the political coalition behind Obamacare. The Republicans would never propose a law like Obamacare. The bill is 2800 pages long. It tries to manage one sixth of our economy from Washington D.C. Rather, what we would do is propose targeted solutions to specific problems in our health care system. So, we’ve already talked about one of them: the lack of access to insurance for people with preexisting conditions, or maybe they lose their insurance, they can’t afford very high COBRA premiums, and then they become uninsured with preexisting conditions. We can provide for preexisting condition risk pools at the state level. The federal government can help with those. We can have a guaranteed renewal provision, like you all have in your employer plans.

So, once you’re in those pools the insurance companies who are providing you that insurance have to renew your plan as long as you continue to pay on time, and guarantee portability, which means you can move from this pool to a employer based plan or into a government based plan, like a Medicare or a Tricare or something along those lines. And then you also have the high cost of health insurance for all of us. I mean, even if you don’t have a preexisting condition health insurance is still pretty expensive. I mean, it’s continuing to increase year after year. Those are accelerating unfortunately, under Obamacare.

Well, how can we address those? I think there the best thing to do is introduce more competition into the marketplace. You know, a lot of you probably have a smartphone in your pocket, an android or an iphone or a blackberry. You know, 25 years ago was the size of a brick and you had to carry it around in what looked like a satchel; and now look at how far we’ve come in 25 years. That’s largely because cellphones and their manufacturers isn’t tightly regulated and overseen by the government. You know, if it was we’d still all be carrying bricks for cellphones. Actually, we wouldn’t be carrying them around because it would only be a luxury good item that the ultra rich could afford. But because you’ve had market forces competing to appeal to the consumers for their dollars, you’ve had innovations. Things that 25 years ago not only did they not have, but you couldn’t conceive. Who would have thought 25 years ago that what looked like a big brick would become essentially a super computer in the palm of your hand.

So, if you introduce those kinds of competitive forces into health insurance you’ll see the same kind of innovation, the same kind of reduction in prices, the same kind of improvement in quality that you see in so many other markets. And what are some simple examples of those? Allowing people to offer insurance across state lines in the health insurance markets the same way you can in home insurance or car insurance markets. Giving individuals the same kind of tax preferences for health insurance as companies get when they buy insurance for their employees.

Or letting small companies pool together so they have the same purchasing power as a big company, since they, you know, have thousands or tens of thousands of employees. You know, in promoting transparency in pricing. So, you know as consumers of healthcare what an MRI costs in one place as opposed to another place because for the exact same procedure and the exact same equipment and the exact same care you might be charged three or four or five times because the costs are at a hospital or clinic.

Those are relatively simple, targeted reforms that don’t try to take over our economy, that don’t have these massive secondary consequences, but I think would introduce market forces that would trust you as individuals and families and trust doctors to make the right decisions about your own care.