Finding the Melody

We are in a series looking at the recently published Republican plan for the ‘repeal and replace’ of the Affordable Care Act. Click here to find other posts in the series.

My high school had just launched a speech and debate team my senior year and our coach asked us to watch the Reagan-Carter debate to get some inspiration. In our debrief the next day, someone noted that Reagan, no matter the question asked, could masterfully turn his answer back to one of his handful of talking points.  It was not evident how inner city schools were negatively impacted by Communism, but in 60 seconds, Reagan had you believing that it was all the Soviet’s fault.

He found the few notes to which a majority of Americans responded and he sang them over and over again, all the way to a landslide victory.

The second big part of the Republican’s ‘repeal and replace’ strategy deals with Medicaid reform.  This is dicey territory for them for a couple of big reasons. 

First, this topic plays into the historical Democratic/Republican narrative and changing that is hard, especially given the incredible ineptitude of any Republican not named Paul Ryan to talk on these matters without sounding to the average American like a bratty, rich trust fund baby. 

Second, taking away a benefit is never easy, and it doesn’t matter whether it should not have been given in the first place. 

But, the policy paper makes clear they think they have found the melody line on this issue.  Before we get into the details, let’s explore the theme on Medicaid reform that they are going to sing, sing, and sign some more: Medicaid, a program designed for ‘children, pregnant mothers, the elderly, the blind, and the disabled,’ is now in grave financial danger because ObamaCare expanded it to provide coverage for ‘able-bodied’ adults.

And yes, you should imagine these words in a boyish Wisconsin accent because that is exactly where they originated.

They have to be careful here because math behind how federal dollars flow differently to states for historic Medicaid beneficiaries compared to those covered in the ACA expansion is complex.  Yes, that effectively means the vulnerable are indirectly subsidizing the able-bodied, but channel your inner Reagan and resist the urge to get lost in the details.  Just sing the melody over and over, and as we say in the south, ‘that dog will hunt.’

(Yes, that is one of the all-time best redneck euphemisms and you Yankees are just a bit jealous that you don’t have something comparable, even if you have no idea what it means.)

To be clear, that dog will hunt with the constituents that put the Republicans in charge and that appears to be the audience to which they are speaking.  That the ‘dog’ won’t hunt in coastal urban centers is irrelevant.

Yes, framing this as slackers taking from grandma is a gross oversimplification of the complexities of Medicaid, and we’ll get into more details next time since we like healthcare policy here, but ask Jimmy Carter and his 49 electoral college votes how well getting lost in the weeds works as a political strategy.

‘Able-bodied’ vs. ‘the most vulnerable.’  Sing it again.

That dog will hunt.


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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