Republican hopes to repeal Obamacare are all but officially dead, at least for now. This isn’t just a failure, this is an epic failure. This is the legislative failure by which all future legislative failures will be judged.
But how did it come to this? When Republicans took power in January, they controlled both branches of Congress and the presidency, Obamacare was hugely unpopular with voters, and the health care law was spiraling into failure. Yet somehow, Obamacare not only survives, it is now more popular than ever.
So what went wrong?
1. It’s Hard Taking Things Away from People: One thing Democrats have always understood is that there is no down escalator for the welfare state. As we witness every election cycle, when Democrats accuse Republicans of throwing grandma off a cliff for discussing Social Security or Medicare reform, it doesn’t matter how unsustainable or unrealistic promised benefits are, you are still taking away something that people feel they were promised. Santa Claus is always more popular than the Grinch, even if the Grinch understands math.
Republicans tried hard to pretend that there were no losers under their proposals, but the public understood that, if you slowed the growth of Medicaid or reduced subsidies, some people would either pay more or get less. And because they don’t trust politicians, they didn’t want to take any chances that the person paying more or getting less would be them. That means it was always going to be hard for Republicans to repeal or replace Obamacare even if they got everything else right. As we saw, they didn’t.
2. Institutional barriers: Because Democrats were unified in opposition to any Republican plan, Republicans were forced to rely on a complex procedure known as “reconciliation” to avoid a filibuster in the Senate. Among other things, reconciliation requires that all provisions in a bill have a direct budgetary impact. Thus, proposals like allowing the sale of insurance across state lines couldn’t be included in the bill. But those provisions were not only among the most popular Republican ideas, they were also important for making insurance more affordable.
3. No Plan: For 7 years, every Republican running for president or Congress (or any other office for that matter) campaigned on opposition to Obamacare. Congress even voted some 50 times to repeal all or part of the health care law. But once the stakes became real rather than symbolic this year, it quickly became apparent that Republicans had no actual plan for what would replace Obamacare. This wasn’t just a question of negotiating the final details either. They didn’t even understand the basics. It was obvious that very few Republicans had given much thought to how the health care system works or what a free market health care plan might look like.
Without a base of understanding to start from, the negotiations over the Republican alternative quickly became obsessive efforts to find a plan that could pass, rather than one that would work. Thus Republicans tried to keep seemingly popular provisions of Obamacare, like preventing medical underwriting of people with preexisting conditions, while repealing unpopular provisions like the individual mandate. They ended up with a proposal that increasingly veered toward incoherence. It somehow managed the difficult feat of taking all the problems with Obamacare and making them worse.
No Message: As Republicans became increasingly obsessed with process and the tantalizing question of whether they could pass anything, they almost completely stopped talking about why they should pass their bill. Almost no one talked about why this was a good bill, or why it was better than Obamacare. The average American had no idea what the Republican bill would do to their premiums, their coverage, their ability to see the doctor of their choice. There is a compelling case to be made for how free market health care reform can bring down costs, while improving quality and choice. No one ever made that case.
No one was more derelict in this regard than President Trump. Say what you will about how President Obama sold Obamacare, but he did sell it. By some estimates Obama discussed health care on more than 150 occasions in his speeches, press conferences, and town halls. Even by generous standards, President Trump spoke about health care less than a dozen times in the first six months of his presidency, often just a passing reference sandwiched amidst other issues.
The Republican failure to repeal Obamacare suggests that the rest of their agenda, from tax reform to the budget is in trouble too. None of the dynamics are going to change. Democrats, firmly in “resist” mode, will remain adamantly against anything Republicans propose. President Trump will remain distracted and disengaged (not to mention increasingly unpopular). Republicans will remain divided and afraid. Not exactly a recipe for success.
The question, then, is whether the president and congressional Republicans have learned anything from this defeat. So far, there’s no evidence that they have.