You may not know the name Rufus E. Miles, Jr., after whom "Miles' Law" is named, but his eponymous dictum is in full evidence as the Republicans make their Sisyphean effort to "repeal and replace" all things ACA.
In 1948, Miles was serving the Truman administration as Chief of the Labor and Welfare branch at the Bureau of the Budget. One of his examiners took a higher paying position at another agency of which the examiner had been highly critical. Miles predicted that the examiner would stop being critical of his new agency and would instead become an outspoken critic of the Bureau of the Budget. Asked why he believed this, Miles said, "Where you stand depends on where you sit." That became known as "Miles' Law."
What may or may not be resolved between the time I write this column and the time you read it is uncertain. What is absolutely certain is that Republican factionalism coupled with the GOP's seemingly genetic inability to effectively message is creating significant challenges for President Donald Trump's "Repeal and Replace" campaign promise.
From the start, the Republicans stumbled in their messaging. The House proudly announced their bill. Mere minutes later, more conservative Republicans were arguing that not only was it nothing close to "repeal," but it failed the "replace" test as well. It took the House leadership several days and a really lame PowerPoint presentation to explain that this was just the first of a multi-part strategy, and that the initial salvo was moving forward under reconciliation because that process carries a lower burden for passing in the Senate.
Yet even that attempt at procedural explanation could not quiet the intra-party factions. Miles' Law applied equally to the House's Freedom Caucus and Republican Study Committee, which felt the proposal retained too many ACA policies and principles, and slammed the creation of a seemingly new entitlement program in the form of tax credits. Outside groups such as Heritage Action and the Club for Growth also piled on the refundable tax credit opposition bandwagon.
Related: Pence gives ACA attack update
And still other traditional conservatives criticized the bill, worrying that it would increase the number of uninsured. Under the ACA, the whole "number of uninsured" argument is at best something of a red herring. Having an insurance card in your wallet is not the same as being able to afford the deductibles, co-pays and other out-of-pocket costs that often come before treatment. Regardless, initial reports of the proposed tax credit amounts may leave many with much higher premium costs, thus reducing the number of insured.
