Will the ACA (aka Obamacare) endure?

The failure of the GOP “repeal and replace” bill was a major defeat for both the President and Speaker Ryan.

Steve Bannon, Trump’s strategic analyst and dark guru, met with the Freedom Caucus to lay down the law.  “You have no choice but to vote for this bill,” Bannon commanded, not realizing that Congress people don’t like being told what to do, even by a White House controlled by their own party.

Bannon’s logic made sense:  If the bill to repeal and replace the ACA fails, then Obamacare survives, perhaps indefinitely.  If the White House gives in to the ultra-conservative freedom caucus, then moderate Republicans would bolt, assuring the bill’s defeat.   However imperfect – only a small reduction in the deficit, despite having 24 million more uninsured within a decade – the legislation  was the only way to keep the promise to “repeal and replace” the Affordable Care Act (ACA).

While some in the freedom caucus were tempted – one person has quit the caucus out of frustration of having the group obstruct the President’s agenda – the three dozen members held true to the belief that the replacement was simply “Obamacare light,” and did not undo the most objectionable aspects of the ACA.

Making things harder for the GOP was that the ACA’s favorability went into positive territory this January – the first time since its passage.  In fact, favorability was + 10% in many polls, a turn around from just a few months before.  The reason: once people started to understand what it would mean to have the act repealed, they had second thoughts.   Republicans in Congress learned that on their ‘town hall meetings’ over the last couple months as well.  Many in the party feared that “Trumpcare” would be a disaster and give the Democrats something to rally around.  Keeping the ACA, anathema to many Republicans, might be best for the party’s electoral chances in 2018.

In an embarrassing gaffe, the American Action Network forgot to cancel ads thanking Republicans for voting to replace the ACA. Oops

So does this mean Obamacare is here to stay?   The odds are good that it will endure.  To be sure, President Trump made what Nancy Pelosi called a “rookie mistake,” trying to ram ‘repeal and replace’ through quickly.  President Obama took over a year to pass the ACA, despite enjoying a much larger majority in both houses.  Obama had to cajole, deal, and adjust the proposal numerous time – health care is complicated, as President Trump recently noted with some surprise.

But it’s very difficult to roll back a government program that helps millions of people.  Once it’s gone, the personal stories of people who lose insurance, and maybe some who die or endure medical cost bankruptcy will become common place, and be a big issue for the Democrats.  Republicans, seeing the popularity of the program, are loathe to do anything to squander the political power they’ve worked ten years to achieve.

Republicans knew Obamacare would be hard to repeal; this is why they tried so hard to delay or prevent implementation of the ACA.  They knew it would be like Medicare/Medicaid had been back in the sixties – extremely controversial to pass, but once in place, all but impossible to roll back.

Ultimately, the ACA has numerous flaws that need to be fixed.  Perhaps a bipartisan effort coming from the Senate can move in that direction, and later gain support from President Trump, who right now absolutely loathes the “freedom caucus.”  But a GOP-only “repeal and replace” looks unlikely.   For a party that voted to repeal the ACA sixty times when they knew it would be vetoed, reality is proving far more daunting.

Signed into law March 23, 2010 – almost seven years to the day that Trump and Ryan pulled the repeal and replace bill – the ACA endures

My prediction: in the coming years reality will force Congress and the President (including whoever comes after Trump) to make changes to the ACA.   Overtime, like Medicaid and Medicare (and before that Social Security) this once extremely controversial bill will become mainstream and accepted by both parties.   People will remember March 24, 2017 as the day that the ACA was on its deathbed, and thanks to hard core conservatives who did not want to compromise, Obamacare prevailed.   Ironically, this may be the best outcome for the Republican party in the long term.  It may also be the point where the freedom caucus and hard core conservatives in the House finally jumped the shark.