I'm so old I can remember a time before critical race theory, Mr. Potato Head and library books about gay teenagers were the greatest threats to America. I know it's hard to believe that anything could ever be more dangerous to all we hold dear, but once upon a time millions of people were convinced that affordable health care spelled the end of the republic as we know it. They took to the streets, mobbed town hall meetings and screamed bloody murder when the government proposed a law that would ban insurance companies from refusing to cover sick people and offered government help to people who could not afford the sky-high premiums those companies charged.
It seems like ancient history now but just a few years ago the hottest, most contentious issue in America was the passage of the Affordable Care Act (also known, for better or worse, as Obamacare). The Republican Party organized itself for almost a decade solely around a promise to repeal it. In fact, they actually voted to do so 67 times over the course of seven years. As president at the time, Barack Obama would have vetoed any repeal, of course, but the act of voting against it was enough to keep the base in line, outraged and on the march from one election to the next.
In the 2016 election, all the Republican candidates had ACA repeal as a top priority. By that time the program was becoming part of people's lives and broadly gaining in popularity, so the GOP had landed on "repeal and replace" as their slogan — a promise to enact something different but equivalent, the details of which they always failed to spell out. Inevitably, the best they could offer was some kind of vague, voluntary state-by-state insurance plan that would be more expensive and grossly inadequate. Nonetheless, it seemed to animate their voters like no other issue. The American right just hated Obamacare, even more than the ancient shibboleths of "welfare" and "affirmative action."
Donald Trump, as usual, took the "replace" promise to new heights. Just days before the 2016 election, he made this vow:
My first day in office, I am going to ask Congress to put a bill on my desk getting rid of this disastrous law and replacing it with reforms that expand choice, freedom, affordability. You're going to have such great health care at a tiny fraction of the cost. And it's going to be so easy.
Well, it wasn't so easy. The House passed a terrible replacement bill in 2017 but it failed in the Senate bill by one vote, after that legendary thumbs-down by Sen. John McCain, who was near the end of his life but wanted a final measure of revenge against Trump, perhaps over his spiteful comments about McCain's record of military service. (I think he was the last Republican, before Liz Cheney, to land a truly damaging blow against Trump.)
Trump tried to move on to tax cuts but must have gotten some blowback from the base. In October of that year he tried to have it both ways, tweeting, "As usual the ObamaCare premiums will be up (the Dems own it) but we will Repeal & Replace and have great Healthcare soon — after Tax Cuts!"
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By that time, Republicans in Congress were counting on the Supreme Court to gut the Affordable Care Act for them, and kept a lower profile on the issue. Nonetheless, Republican candidates for office still ran on the promise and Trump kept saying the bill was almost ready, so the base was supposedly still excited at the prospect — dampened a bit, no doubt, by GOP losses in 2018. As the 2020 election cycle began, Trump started campaigning on repeal-and-replace again, claiming he would announce a new plan "in two months, maybe less." That didn't happen, and as usual he just started saying whatever he thought people wanted to hear: A plan would be "ready in two weeks" or "by the end of the month," or he was just about to issue an executive order "requiring health insurance companies to cover all preexisting conditions for all customers," something he claimed had "never been done before." His crowds cheered deliriously, no doubt believing that just as he'd surely finish his wall he'd get that done in a second term as well.
Trump kept promising a new health care plan "in two months" and then "two weeks," and then vowed to issue an executive order to force insurance companies to cover everything at no cost. Somehow we never got to see this fabulous plan.
Trump lost that election — in reality, if not in the collective imagination of his fans — so we never got to see that fabulous health care plan that would cost nothing and cover everything. Still, losing elections had never stopped the Republicans from running on the issue anyway. Repealing Obamacare was their holy grail for almost a decade, until they suddenly stopped talking about it. So what gives? Why haven't we heard anything at all about it this election cycle?
Well, as NBC News reports, the Republican commitment to ensuring that millions of people suffer from unnecessary illness, death and bankruptcy just isn't sexy anymore:
With slightly more than a month before the next election, Republicans in Congress and on the campaign trail aren't making an issue of Obamacare. None of the Republican Senate nominees running in eight key battleground states have called for unwinding the ACA on their campaign websites, according to an NBC News review. The candidates scarcely mention the 2010 law or health insurance policy in general. And in interviews on Capitol Hill, key GOP lawmakers said the desire for repeal has faded.
House Minority Leader Kevin McCarthy's recent "Commitment to America" made no mention of it either, although the chairman of the ultra-conservative Republican Study Committee did put out a plan that included an unspecified reversal of "the ACA's Washington-centric approach." When asked about it, however, he told NBC that it would be up to McCarthy, the presumptive incoming House speaker, to put it on the agenda.
Interestingly, while it's true that Obamacare is popular, it's not all that popular. A Kaiser Family Foundation tracking poll found that 55% of U.S. adults approved of the ACA while 42% disapproved. So it's not liek the GOP base hasn't come around. They're just bored with being angry about it and have been distracted by all the more exciting new grievances of the moment.
Kevin McCarthy and Rick Scott don't talk about Obamacare in 2022 — maybe because the GOP base likes their racism undiluted these days.
Repealing government-guaranteed health care has been a fundamental principles of the right wing for as long as I can remember. Medicare and Medicaid (aka "entitlements") have perennially been on the chopping block. I assume Republicans still hate it for the same reason they've always hated it: The wrong people may benefit, and that makes it unacceptable. They've got no major problem with government social programs — as long as they're targeted to "real" Americans, if you know what I mean.
Over the past few years, however, the principles that have always been just below the surface of conservative hostility toward egalitarian government programs have evolved from implicit racial animosity to more explicit demands for racist policies and a full-blown assault on the democratic process. The impulses really haven't changed but the right is now willing to experiment with extremist tactics to achieve their goals.
Still, I would never say they've entirely given up on repealing Obamacare. While Sen. Rick Scott of Florida, the Senate Republican campaign chairman, doesn't specifically mention it in his audacious governing agenda, he still wants to "rein in" Medicare and Social Security (through unspecified cuts in benefits or services). Some things never change. I would imagine that Obamacare will soon be viewed as another "entitlement," which must be cut for our own good. For the moment, however, let's take a moment to recognize that Democrats managed to defeat Republicans in one of the biggest policy battles of this generation. The war, needless to say, continues on other fronts.