Republicans know they hate Obamacare, but they still have no alternative plan. Photo: Chris Maddaloni/CQ Roll Call

It became something of a running joke for years on end: Despite provoking 70 congressional votes on measures to repeal the Affordable Care Act, Republicans still did not have any sort of consensus plan for addressing such basic problems as the millions of Americans without health insurance or the insurance-company practice of denying coverage to those with preexisting health conditions. Yes, they could tell you what they opposed. (Basically any Democratic-supported effort to expand coverage via public or private means or a combination of the two, like Obamacare.) And Republicans went to a lot of effort in the courts and state legislatures and, after 2016, via federal executive action to undermine the ACA and its protections, usually on grounds that Obamacare made health insurance more expensive for the people who didn’t much need it.

To a considerable extent, Republicans in Washington were inclined to dump all the problems of the health-care system on the states, which is why some described the idea of repackaging federal health-care dollars into block grants for the states as the GOP “plan,” though it was the very opposite of one in terms of providing national protections.

GOP fecklessness on health care was by nearly all accounts a significant factor in Democratic midterm gains in 2018. Given the continued efforts of the Trump administration and Republicans in the states to blow up Obamacare in the courts (though they rather disingenuously asked the Supreme Court to wait until after the 2020 elections to decide their case), and their continued inability to come up with a comprehensive approach to health-care reform of their own, Democrats entered 2020 planning to emphasize this issue again.

And then came the coronavirus pandemic.

Has that changed the Republican posture on health-care policy? Not in any significant way. Yes, the Trump administration has endorsed the idea of using coronavirus stimulus funds to reimburse hospitals for treatment of uninsured coronavirus patients. But there’s still no plan for the millions of people without insurance who are at risk of infection (not to mention other life-threatening ailments), much less for the many millions of additional Americans who will lose employer-sponsored health insurance as they lose their jobs. And the GOP position is still characterized by unrelieved hostility toward existing programs that might help, as NBC News observes:

The clarity in Trump’s health care vision begins and ends with repealing the Affordable Care Act …

His budget proposals would strip away funding for the law, and he has endorsed a lawsuit to wipe it off the books. But the president hasn’t thrown his weight behind a replacement bill or even an outline, and he has rejected calls to reopen Obamacare for enrollment during the current crisis.

Trump’s focus on mitigating the economic damage has kept health care on the back burner. Some allies worry that with millions of newly unemployed Americans poised to lose coverage during a public health crisis, Trump’s lack of a plan for the needy will be a political liability in his re-election bid.

No kidding.

The focus by Democrats on the nonexistence of any GOP plan to expand health coverage — alongside efforts to shrink coverage via the Obamacare exchanges or Medicaid — is certain to become intense now that they are no longer arguing about the ultimate health-care plans of their own presidential candidates. Much as progressives may find Joe Biden’s health-care proposals inadequate, they look like a veritable horn of plenty compared to anything coming out of the opposing party. Yes, conservative policy wonks have developed theoretical plans, mostly involving high-deductible catastrophic care policies, perhaps supplemented by health-savings accounts. But now more than ever, in a national health emergency, they look howlingly out of proportion to the current situation.

Presumably, Trump will try to take credit for whatever emergency measures Congress provides for dealing with immediate coronavirus-related health costs and try to get across the finish line in November without the “phenomenal” plan he has been promising since 2016. But if they are competent, 2020 Democratic candidates from Joe Biden on down will make this not only a policy emphasis, but a token of all of Trump’s many broken promises, which have brought the country and its most vulnerable people to the gates of living hell.