The Republican Party’s seven-year crusade against Obamacare is effectively over.

Sen. Susan Collins, R-Maine, announced her opposition to the latest repeal effort on Monday, joining Sens. John McCain, R-Ariz., and Rand Paul, R-Ky., to likely end any chance of the bill getting 50 votes in the Senate.

Now begin the recriminations over who is responsible.

The GOP’s failure can be traced to a single tactical blunder: the decision to repeal and replace Obamacare in a single bill — A decision, of course, that doomed the party’s efforts to do both.

The GOP’s gloomy predicament at present stands in stark contrast with the year’s auspicious beginning.

Back in January, Republicans appeared set to finally repeal Obamacare using budget reconciliation, a special process enabling them to overcome a Democratic filibuster in the Senate. While the rules governing this process limited what could be included in a reconciliation bill, congressional Republicans had already demonstrated in 2015 they could target most of Obamacare successfully without violating those rules.

Notwithstanding then-President Barack Obama’s veto of the legislation, the 2015 effort gave Republicans a blueprint for repealing Obamacare as soon as there was a president in office who would sign the legislation.

With the inauguration of President Trump, Obamacare’s opponents controlled the Congress and the presidency for the first time since the law was enacted.

Obstacles hitherto preventing Republicans from repealing Obamacare suddenly vanished. The only thing left to be done was for Congress to resurrect the 2015 bill and send it to Trump to be signed into law.

To not complicate the effort, the only change to the 2015 bill contemplated by Republicans was the inclusion of a multi-year transition period to give Congress more time before repeal took effect. The longer period made it possible for Congress to consider its replacement plan in a step-by-step process.

As part of that process, Congress would first tackle healthcare regulatory reform. It would then consider the extent to which federal assistance was needed to offset the cost of healthcare, as well as the best mechanism to deliver that assistance to the people who needed it. Finally, the GOP anticipated taking up Medicaid and Medicare reforms as part of its larger effort to reform the healthcare system.

Plans were also developed by the Trump transition team detailing the various steps the incoming administration should take absent congressional action to help stabilize the insurance markets in 2017 and 2018 while the replace debate unfolded.

The crucial part in all of this was that Congress start the process by passing the 2015 bill as soon as possible. Failure to do so would preclude the deliberative process necessary to develop the replacement plan, as Obamacare would continue to prevent a real debate over healthcare policy, just as it had done for the last seven years.

But not everyone agreed with the approach. For example, some health policy wonks on the right dubbed the plan “repeal and delay,” arguing it would make it harder to repeal Obamacare in the end. They believed Republicans would pay a political price if they repealed the law before developing a comprehensive alternative of their own. Their recommendation was that Republicans not move forward with repeal until they had written their own plan and built a broad political coalition in support of it.

In addition, some movement conservatives also criticized starting the process by passing legislation virtually identical to the 2015 bill as originally planned. They pushed Congress to go beyond it to repeal all of Obamacare, even though doing so would require Senate Republicans to rewrite the precedents governing the reconciliation process so they could strike down Obamacare in one fell swoop.

Both critiques helped slow momentum on the repeal effort at a critical juncture. Halting the push for repeal and calling for the 2015 bill to be opened back up gave some wavering Republicans who had already voted for the legislation once before a chance to walk away from it completely.

The only way that Republicans could restart the process was by adding a plan to replace Obamacare to the legislation repealing it.

This fateful decision had three consequences which led the repeal effort to fail.

First, Republicans made it less likely that they would either repeal Obamacare or replace it by combining the two. This precluded the bipartisan support needed to enact stable policy reforms over the long-term. Democrats in Congress were unlikely to engage in negotiations over the bill’s replacement provisions if the price of doing so was to facilitate Obamacare’s demise. Doing so would have acknowledged Obamacare had been a failure, which was something Democrats have been unwilling to concede.

Second, the GOP’s inability to repeal Obamacare before considering how best to replace it meant any changes to the law would be considered in the context of the framework it established. As a result, the various repeal and replace bills proposed in Congress over the last eight months effectively restructured Obamacare’s funding mechanism without addressing the law’s underlying cost drivers or sufficiently grappling with the role of the federal government in regulating healthcare.

Finally, the unique dynamic created by combining repeal and replace in the same bill put Republicans in an impossible position. On one side, they risked alienating their core supporters to whom they had repeatedly promised to repeal Obamacare over the last seven years. On the other, Republicans faced a deteriorating status quo and the increasingly likely prospect of working with Democrats to stabilize the market and fix the law they had sworn to eliminate.

This is not how Republicans expected their long crusade against Obamacare to end. They began the year assured of victory. But a tactical blunder left them unable to escape defeat.

Image by Steve Heap


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