The Obamacare Trap

After seven years of making Obamacare repeal their number one objective, Republicans have fallen into a trap of their own creation and revealed to the country that they are not prepared to be a governing party. This afternoon, they abandoned their repeal measure when they couldn’t assemble a winning House coalition despite the unanimous desire in their caucus to uproot President Obama’s signature achievement. The bill produced by House leadership with the approval of the president was rejected by radicals angry that it didn’t extract Obamacare by the roots and by politically astute conservatives who understood they couldn’t explain to their constituents why 24 million people would lose coverage and countless more would lose benefits if the bill became law. Despite casting over 60 ceremonial votes to repeal the Affordable Care Act when Obama was in the White House, the pressures of having to live with the consequences of their actions proved too much for a caucus that had to confront political reality for the first time.

The “repeal and replace” mantra was good politics, serving as a rallying cry for the Republican base. No objective has animated the modern Republican Party more than repealing Obamacare and replacing it with something better. Their narrative was simple and clear: Obamacare is a disaster, a threat to personal liberty, an example of government overreach, and the source of skyrocketing healthcare costs. During the presidential campaign and the first months of his presidency, Donald Trump said he would replace it with a “beautiful” plan that would cover everyone at a lower cost with better benefits, and that he could make it happen quickly because of his legendary negotiating skills.

But slogans are not policies, and Republicans had little more than disingenuous claims to support their rhetoric. Obamacare maintains the private insurance market and does not include a public insurance option, but that hasn’t kept Republicans from characterizing it as a big government program that threatens freedom of choice, as if people were clamoring to choose among insufficient or overly expensive healthcare options in order to preserve their liberty. Obamacare may be complex and imperfect, but calling it a disaster always seemed to apply more to the “Obama” portion of the measure rather than the “care” stuff. For those who most opposed the previous president, his lasting legacy was a lightening rod. For everyone else, opposition to the ACA has mellowed as people have had the chance to get used to it and realize its benefits.

In the real world, an attempt to improve Obamacare would meet with strong public support. But Republicans were trapped by repeal and replace. Over the years it has become their brand. When they found themselves unexpectedly in control of the White House and congress, it became legislative item number one. But replace it with what? A functional governing party would be ready with the answer, yet Republicans were never able to devise a functional free market alternative to Obamacare that satisfied Donald Trump’s promise of universal coverage, lower premium costs and excellent care options, because the free market alternative is, effectively, Obamacare, and all other viable options really are government run.

It took Republican leaders weeks to produce a bill, and when they did it was clear they had abandoned Trump’s populist charade—which appeared to upset no one in leadership, including Trump himself, who blithely ignored his campaign promises in order to get a “win”. The Republican bill could have been sold as an effort to roll back the welfare state or unwind the tax burden on the wealthy, but that’s not what they or their standard bearer had been promising working class voters. They had no choice but to market it as an improvement on the status quo when it was obvious to everyone that it was not. Chaos ensued. Absent a policy that aligned with their rhetoric, Trump and Ryan appealed to tribal loyalty in a frantic effort to pass the bill. They asked reluctant members to put party interests ahead of personal politics, correctly recognizing that everyone from the president on down would be damaged if the party couldn’t come through on its most prominent promise. But when it became apparent that there just weren’t enough yes votes, it made no sense for anyone to sacrifice their futures by voting for a measure they couldn’t defend, and the bill collapsed.

When Republicans were in the opposition, it didn’t matter how much their rhetoric deviated from reality. But reality was the only thing that mattered today. Given the outpouring of constituent anger we have seen in districts across the country, advancing a bill that widely undermined healthcare benefits would have put their majority at risk. But the cost of failing to advance the party’s number one priority also puts their majority at risk, given how demoralizing it will be to base voters who waited years for this moment only to see it end in failure. This is the trap Republicans have created for themselves.

A party tends to face internal strife at the end of a regime cycle when its constituent groups are at odds with each other, their differences proving greater than the once-unifying effect of now outdated or discredited ideas. Several months ago, I suggested that the Republican government might experience this fate, that Donald Trump could end up occupying political space analogous to Jimmy Carter, unable to move major legislation despite having numerical majorities in congress. For today at least, Republicans made Carter look good.