GOP Hoping Empty Health Care Rhetoric Can Save Their Senate Majority

John James, a Michigan Republican running for the U.S. Senate, represents one of the GOP’s best chances to take a seat away from the Democrats.

But James has also run into a familiar political problem for Republicans. Back in 2017, he called for repealing the Affordable Care Act, describing the law as a “monstrosity.” Now he is under attack for trying to take away the law’s protections for people with preexisting conditions.

In response, James has adopted a strategy Republicans around the country have used. In a widely circulating television advertisement and in interviews with local journalists, James has cited a family member’s medical problems ― specifically, his son’s asthma ― as proof that he would always look out for people with preexisting conditions.

“My son has a preexisting condition … I will always fight to protect your health care,” James told WXYZ-TV, the ABC affiliate in Detroit.

And in an interview with WMMZ-TV, the ABC affiliate in Grand Rapids, James said, “I understand firsthand how important it is to protect our family members and people with preexisting conditions. … I will not support any plan that pulls the rug out from under people.”

That vow, not to support a plan that “pulls the rug out from under people,” may sound familiar. It’s the same promise Republicans kept making in 2017 after Donald Trump became president and they were trying to write repeal legislation.

But if you remember the promise, you may also remember how empty it was.

The bills Republicans produced that year would have weakened protections for people with preexisting conditions while leaving many millions without insurance, as independent analysts, including the Congressional Budget Office, confirmed.

The reality is that Republicans have never produced alternatives to “Obamacare” that live up to their lofty rhetoric. They didn’t in 2017 and they aren’t now.

James, a 39-year-old West Point graduate who flew Apache helicopters in Iraq, is a rare bright spot in what’s been a dismal campaign season for the Republican Party nationally. Trump’s chances of winning reelection seem lower every day, and the GOP’s 53-47 Senate majority is in jeopardy, with incumbents from even strongly conservative states, including Georgia and South Carolina, suddenly looking vulnerable.

The incumbent in Michigan isn’t a Republican, however. It’s Democrat Gary Peters, a well-liked but not especially well-known former investment adviser who has spent nearly 30 years in politics ― as a city councilor, state senator, lottery commissioner and then a U.S. House member before succeeding Democratic Sen. Carl Levin in 2015. 

James, who has an MBA from the University of Michigan and works in his family’s supply chain business, has played up his credentials as both a businessman and a fresh-faced, energetic outsider. It may be working.

A New York Times/Siena poll out Monday showed him trailing Peters by just 1 percentage point, 42% to 43%. It’s only the latest poll to suggest the race is close, even as Democratic presidential nominee Joe Biden has maintained a relatively comfortable lead in Michigan. 

Both parties recognize the stakes, which helps explain why the James-Peters race is on track to be the most expensive in the state’s history. Much of that has gone toward television advertisements that focus on health care ― including one from Peters that features a 2017 video of James bemoaning the GOP’s failure to repeal the Affordable Care Act. 

“Our failure to repeal and replace Obamacare is the surest sign that we need someone who will go and work their tail off to remove this monstrosity,” James says in the clip, which he recorded while he was seeking the GOP nomination to run against Michigan’s other Democratic senator, Debbie Stabenow. It was a key issue in his campaign; in an October 2018 debate, James said “we took a system that was broken and made it worse.” 

But, by that point, the politics of health care in Michigan was shifting in the same way it was shifting nationwide. Voters started to appreciate what the Affordable Care Act, for all of its flaws, had achieved. And they got angry at Republicans for trying to take those things away. 

James tried to deflect the anger by insisting that, notwithstanding his support of repeal, he was committed to preserving protections for people with preexisting conditions. He lost anyway.

And although it’s impossible to know what role health care played in that race, analysts agree it was a big reason why Republicans nationally suffered such big losses, enough to cost them control of the House of Representatives.

Now its control of the Senate in doubt, and the Affordable Care Act is a top issue again, thanks in part to a new lawsuit challenging its constitutionality that the Supreme Court is expected to hear in November ― quite possibly, with Trump nominee Amy Coney Barrett in the seat that Justice Ruth Bader Ginsburg once occupied. 

If the court decides to throw out the Affordable Care Act, even in part, devising a replacement will fall to whoever is in the White House and whoever is running Congress. In other words, a lot would depend on who wins in November and what they are prepared to do.

So far, the campaign is playing out a lot like it did in 2018, with Republicans insisting, again, that they would never take away protections for people with preexisting conditions. Several are running ads featuring family members who fought medical problems, just to prove how serious they are.

In Nebraska, an ad for Rep. Don Bacon ― who famously declared himself a “hell yes” on repeal legislation in 2017 ― talks about a sister who died of cancer and proclaims that he is “committed to affordable health care and protecting preexisting conditions.”

In Colorado, an ad for Sen. Cory Gardner, who also supported repeal legislation, showcases his mother, a cancer survivor. Then he promises to protect people with preexisting conditions “no matter what happens to Obamacare.”

Gardner has justified that claim by pointing to the “Pre-existing Conditions Protection Act,” a bill he sponsored. But the entire legislation is barely 100 words long and is basically just a slogan, as multiple analysts pointed out.

“It’s an adorable little bill but does not address any of the main issues,” Linda Blumberg, a fellow at the Urban Institute, told Kaiser Health News. “You need a package of policies working together in order to create real protections for people to have coverage to meet their health care needs.” 

The story with James in Michigan is pretty much the same. 

“John has always said that if we repeal the ACA, there must be a replacement in place that protects people with preexisting conditions,” campaign spokesperson Abby Walls told HuffPost.

But when the Detroit Free Press editorial board pushed James for details on how he would do that, he said he’s “not a healthcare expert” and that he’d rely on “experts” to work out a “market-based solution.” The Free Press ultimately endorsed Peters.

And in that WZZM interview, James dodged questions for a full 10 minutes while correspondent Nick LaFave repeatedly (and admirably) tried to get him to offer something, anything, resembling a specific proposal. The most James would say is that he thought more transparency about hospital prices would bring down prices through competition and that “I believe the decision-making should go to the people, not the federal government.”

Making it easier to see hospital prices and giving consumers more choices might or might not improve health care access at the margins, but it’s not a substitute for the structure the Affordable Care Act has put into place.

It’s also not a substitute for the hundreds of billions of dollars that the Affordable Care Act spends every year on private insurance subsidies and expanded Medicaid ― which, in turn, has improved financial security, access to care and health outcomes for hundreds of thousands of Michiganders.

This is always the problem for Republicans. Making insurance available to everybody typically requires some combination of government spending, taxes and regulations. And these are not things Republicans want to do.

“While it seems that every candidate — including President Trump — is vowing these days to protect people with preexisting conditions, you can’t just click your heels together three times and make it come true,” Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation, wrote recently.

The Affordable Care Act has its shortcomings and tradeoffs. Nobody, not even its staunchest defenders, think it’s the ideal response to the problems of America’s health care system.

Still, it’s a response, which is more than James has offered. It is one more reason to treat his promises on health care, like those from so many other Republicans, with extreme skepticism.