The latest Republican strategy – cutting off your nose to spite your face.

No, this is not about plastic surgery.

The phrase refers to one who attempts to do harm to another, but in so doing harms themselves

Yep, we are talking about health reform.

The Affordable Care Act as Republican policy

President Obama has rebutted criticism that his health care reform was too radical by arguing that it is modeled after successful legislation that became law in Massachusetts under then Republican Governor, Mitt Romney – and that was based on ideas originally proposed by the Heritage Foundation.

From the perspective of the ivory tower of the Heritage Foundation, or from the myopic world of Republican health care policy, there may actually be some arguable distinction.

But from the perspective of real health care reform, say single payer, it is a distinction without a difference.

The only thing that separates Obama’s Affordable Care Act from Mitt Romney’s Massachusetts imitative is the political affiliation of its author.

As soon as Obama and the Democrats signed on, Romney signed off.

The Affordable Care Act as Democratic policy

But Romney wasn’t the only one to turn and run from an idea they once embraced.

Tim Pawlenty, a Republican contender for president briefly, thought Mitt Romney was on to something in 2006, the year of the Massachusetts healthcare reform law.

He expressed openness to the concept of the individual mandate and support for the idea that everyone should be in a health care plan.

Likewise John Huntsman was an eager proponent of health reform measures that would expand coverage.  He openly supported the individual mandate until it was obviously going nowhere in Utah.  He settled for a more modest version of the insurance exchange concept that distinguished Romney’s legislation.  Utah and Massachusetts are the only working models for the other states trying to implement health care exchanges.

The pickle

Three of the current field of Republican candidates endorsed in some way, the concepts central to what is now derisively referred to as Obamacare – individual responsibility, make the markets work better, allow for profit insurance companies.  Don’t they sound like concepts that are more likely to come from the Republican side of the aisle?

But they have the name of the current President associated with them and for that reason, Republicans will not allow them to succeed.  It’s personal, you see.

State Exchanges

Take the state health insurance exchanges.  Another idea that is more likely to be associated with Republicans than Democrats – allow each state flexibility in setting up their own exchanges.  But if they don’t create their own exchanges, the federal government will do it for them.

This seems to put some Republican governors in a rather curious pickle.  If they do create an exchange for their own state, they would be adopting values traditionally associated with Republicans:  individual responsibility, the growth of a new market for insurance companies, local autonomy.  The alternative is generally not attractive to Republicans – let the federal government do it.

But there is a catch.  It is a catch that some Republican governors just cannot bring themselves to overcome.  By consenting to the creation of their own exchange they would be acquiescing to the will of President Obama.

It’s personal, you see.

Kansas Governor, Sam Brownback (R) turned down federal seed money to start its exchange.  He piously asserts that, given pressure on the federal government to reduce expenditures, states should not rely on the feds in setting up their own exchanges.  But the absence of federal funds has halted Kansas’ progress to create its own exchange, which may prompt a federal takeover.

Oklahoma Governor, Mary Fallin (R), turned down federal money to help it build its own exchange.  Sounds noble enough.  They want to do it themselves.  Or do they?  According to the Governor, she was “pleased to announce this agreement that accomplishes my goal from the very beginning: Stopping the implementation of the President’s federal health care exchange in Oklahoma.”

Florida Governor Rick Scott (R), has declined federal funds to set up an exchange in Florida, an exchange the state has yet to authorize.  Remember Rick Scott? – the guy who made his money as the head of a for profit hospital chain that pleaded guilty to defrauding the federal government and paid almost $2 billion dollars in settlements.

Texas Governor, Rick Perry, (R), presiding over the state with one of the highest rates on uninsured residents,  has vowed to oppose any effort to create an exchange in Texas as long as the legal questions around the Affordable Care Act are unresolved.  That does not mean he cannot accept the grant money handed out by the feds to create the non-existent exchange, not to mention $60 million in Early Retiree Reinsurance program grants – also a part of the Affordable Care Act.

Louisiana Governor Bobby Jindal (R), has also refused to set health care insurance exchange in his state because it would advance Obamacare regulations.

It’s personal, you see.

It doesn’t have to be rational.

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