For seven years, Republicans vowed to repeal and replace the Affordable Care Act, also known as Obamacare. They have struggled mightily to do so; their most serious effort was the introduction of the Better Care Reconciliation Act in June.
If the problem is that wealthy people don’t have enough money, and poor people have too much health care, then the BCRA was an appropriate solution. It is unclear why tax cuts are central to a health care bill, but clearly they are to an important Republican constituency, because cutting taxes on the upper classes (the average cut for the top 0.1 percent would be $195,610, while the bottom 80 percent would get no tax benefit) have generally been a part of every Republican bill.
After the BCRA failed to pass, it seemed that Republican efforts to repeal and replace Obamacare were finally done. Fearing the failure to pass anything would torpedo the rest of the Republican agenda, Senate Majority Leader Mitch McConnell made heroic efforts to salvage victory from the jaws of defeat, including having Sen. John McCain dramatically fly back to Washington, D.C., from Arizona after surgery and a diagnosis of brain cancer to cast the deciding vote that enabled the Senate to debate the issue on the floor.
A few days later, however, after the Senate had failed to pass several different versions of the bill, McCain even more dramatically cast the deciding vote to quash the final effort, a bill known as the “skinny repeal,” because it was supposed to be the barest bill Republicans could agree on.
When the Republicans control every branch of government, and can therefore pass any legislation they want without any Democratic support, which has been their strategy, why are they having so much difficulty repealing and replacing Obamacare? While this might appear to be a case of it being easier to criticize what someone else does than doing it yourself, the problem is deeper than that. The main problem is that Obamacare is, in fact, a Republican approach to providing health care.
The GOP is struggling to come up with a Republican alternative because Obamacare includes most of the best elements of a conservative approach. And while they could improve it by tweaking things, if they did that they’d have to admit that Obamacare is essentially working, and that their opposition has always been based on politics or worse, rather than policy.
An additional problem is that there is a division within the Republican Party with regards to health care. Ideological conservatives do not think universal coverage is important, and do not like the idea of government involvement in healthcare at all, on the premise that government-provided health care is part of a “hammock” that destroys individual ambition, so they see a reduction in the number of people getting Medicaid as a good thing, while Republican governors, moderate Republican senators, and the general public are appalled at the impact that the BCRA’s drastic cuts to Medicaid would have had.
McConnell’s recent failure to find any combination of 50 votes to repeal and replace Obamacare demonstrates the difficulty of the task. Maine Sen. Susan Collins opposed the GOP plan because it went too far, while Rand Paul, a Kentucky Republican with libertarian leanings, opposed it because it did not go far enough. McConnell undermined his credibility with his own party when he attempted to sell the bill to moderates by telling them not to worry about the Medicaid cuts down the road, because they would never happen. This was a little disconcerting to conservatives who were supporting the bill because of those cuts.
Democrats also face a dilemma. Politically, they have focused on defending President Obama’s legacy and Obamacare is central to that legacy. Additionally, preventing the Republicans from delivering on their promise to “repeal and replace” demonstrates GOP ineptitude, and jeopardizes the entire Republican agenda, because there is even less agreement in the party’s ranks on tax reform and immigration policy.
On the other hand, one could argue that any of the bills the Republicans attempted to pass were so harmful to so many voters that politically it would have benefited the Democrats if Republicans had actually passed something, since voters would then truly understand Republican priorities, creating a political backlash that would have paved the way for a Democratic tsunami in 2018. A Democratic Congress would then have the political capital to pass a single-payer health plan, or Medicare for all.
But passage of any of the Republican plans would have denied a lot of people health care, causing tangible harm, which is too high a price to pay for Democratic success in the 2018 elections. While Republicans may try to revisit the issue, the failure of these bills was good for everyone – probably even Republican politicians.
James is a East Washington resident and has a doctorate in history and policy from Carnegie Mellon University.