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Four Reasons Obamacare Lived to Plague Republicans Another Day

Michael D. Tanner

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.

For one, Santa Claus is
much more popular than the Grinch.

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.

Michael Tanner is a senior fellow at the Cato Institute.