Bradley B. Burroughs, United Theological Seminary
More than any other, the central objective of Republican Party since March of 2010 has been to repeal and replace the Affordable Care Act (ACA), more commonly known as “Obamacare.” Between 2011, when Republicans gained a majority in the House of Representatives, and 2016, the House took votes on at least 67 bills that involved repealing, replacing, or defunding the ACA either in parts or as a whole.
Galvanized by the election of President Trump, efforts to repeal and replace have received new energy in 2017. In March, House leadership brought forward the American Health Care Act (AHCA). In part due to a report from the Congressional Budget Office (CBO) that estimated that the bill would add 24 million Americans to the ranks of the uninsured by 2026, support for the bill never solidified, and it was ultimately withdrawn. In May, however, a revised version of the AHCA was pushed through the House before the CBO score was finalized. (The CBO ultimately projected that the uninsured population would increase by 23 million.)
Setting aside the House bill, the Senate, in a highly secretive process, developed and has now released its own repeal-and-replace bill. Despite admonitions from President Trump that they should be “more generous” than the House bill, which he described as “mean, mean, mean,” CBO scoring has concluded that the Senate bill only reduced the projected number of those who would lose insurance coverage to 22 million. That is despite the fact that many measures likely to increase the number of uninsured do not take effect until after the 10-year window considered in the CBO assessment.
The tenacity of repeal-and-replace efforts, of course, expresses Republicans’ commitment to small government, or at least—especially given the vast expansion of military spending in President Trump’s proposed budget—to slashing certain forms of government spending. And while the bill has a number of obstacles yet to pass before it would become the law of the state, on a deeper level these efforts by the party in power also exemplify one of Reinhold Niebuhr’s most keen and cutting insights, namely, that every state is always ethically ambiguous because it seeks the good of a limited group rather than the community as a whole.
Niebuhr articulates this point powerfully in his 1937 essay “Do the State and Nation Belong to God or the Devil?” As Niebuhr defines it, the state is “the bearer of power in the community.” This power is of two types. On the one hand, the state uses coercive power. Whether it is in the form of military might or economic ownership, the state bears the power to force subjects into line. But even more crucially, it also possesses the power of prestige by which it convinces rather than coerces the populace to obey.
What makes the state ethically ambiguous in Niebuhr’s view is not that it uses coercive power but that whatever form of power it uses, whether the power of coercion or of majesty, “is ostensibly derived from the total community and justified by its service to the community” even as that power truly serves a only a limited ruling class. The state generally claims that it provides for the good of all in the community, for instance by promising, as President Trump did in January, that there will be “insurance for everybody.” And yet in practical terms it inevitably serves the interests of the ruling classes, such as by slashing insurance subsidies and Medicare funding while pursuing large cuts for corporations and high earners.
The problem of serving limited interests is one that plagues every state. “Power,” as Niebuhr reminds us, “is always partial.” A similar, though perhaps obverse, indictment could be written of every previous administration. And yet, even if previous administrations or other proposed policies would be also indicted, that does not mean that they are equally indicted. And, as Niebuhr repeatedly reminds us “civilization depends upon our decisions in the ‘nicely calculated less and more’ of good and evil in political institutions.”
Although the problem that power serves partial interests can never be resolved, it must be addressed. It is for this reason that Niebuhr calls us to the kind of “prophetic religion” represented by Amos, who excoriated the ruling calls for “reading upon the poor” (Amos 5:11). Such a prophetic religion “speaks a word of judgment against ever ruler and every nation” and calls them to serve the interests of all, especially the most needy. Accordingly, it makes an indispensable contribution in the pursuit of justice.
While he faltered in key instances, Niebuhr often spoke such a word boldly and provocatively, serving as an American conscience. The desire for justice must lead us to hope that by the power of God such a prophetic religion and such a conscience may be ever renewed among us.