Many responses in this thread exemplify that prediction.
Now, even if the ACA does get repealed, it certainly wasn’t as quick or easy as many in that thread thought. So what happened? Did something argued in that thread not come true, or did something said by the opposing side happen?
The Republicans in Congress can’t actually come out and say this, but I figure it explains everything: until they actually repeal the ACA, anyone who hates their current situation can say, “Man, I sure do hate this Obamacare crap.”
Those folks will hear that the GOP is, so far, unable to do repeal-and-replace stuff; which, granted, sounds bad if you want it repealed. But you’ll also hear that the Dems don’t want it repealed, which sounds worse, right? I mean, sure, get a little frustrated at the side that’s trying and failing – but that can’t send you running into the arms of the party that isn’t even trying, y’know? ‘My bad situation was caused by Democrats, and the Republicans are working on it and the Democrats aren’t.’
And then there are the folks who like their current situation; and, given what got said during the campaign, the least bad thing – the most reassuring thing – that they could hear about the GOP is, well, ‘they’re unable to do repeal-and-replace’.
As soon as it’s repealed, folks who are currently miserable and folks who are currently happy can both blame the GOP for everything. But until that actually happens, you can merely say that the GOP hasn’t done wrong by you – regardless of whether you tack on a quick “but the Democrats sure have.”
Short version: bullshit makes for great campaign slogans but terrible actual policy.
Long version: what actually is the republican policy on healthcare? What do republicans in power actually want out of health care? The answer is really not what they’ve been selling. They say they want cheaper, more effective universal health care. This is an excellent campaign slogan, because Obamacare is far from ideal and a lot of people recognize that. Their actual position? They oppose universal healthcare. As Vox puts it:
The fake, but popular, position goes something like this: Conservatives think everyone deserves affordable health insurance, but they disagree with Democrats about how to get everyone covered at the best price. This was the language that surrounded Paul Ryan and Donald Trump’s Obamacare alternative — an alternative that crashed and burned when it came clear that it would lead to more people with worse (or no) health insurance and higher medical bills.
Conservatives’ real, but unpopular, position on health care is quite different, and it explains their behavior much better. Their real position is that universal coverage is a philosophically unsound goal, and that blocking Democrats from creating a universal health care system is of overriding importance. To many conservatives, it is not the government’s role to make sure everyone who wants health insurance can get it, and it would be a massive step toward socialism if that changed.
That’s an easy and quite powerful deception to uphold when you don’t have the power to institute it. When you control every branch of government, the people who voted for you expect results, it’s… difficult* to suddenly turn around and say, “Surprise! We have been complaining about how Obamacare is too expensive, makes healthcare unaffordable for some citizens, and all these other things you folks care about! Now we’re going to pass a bill that makes health care way more expensive, coverage worse, shreds medicaid, and we’re doing it so that we can pass a big fat tax cut on the rich!”
*Also: duplicitous, insanely dishonest, downright evil, obscene, contrary to every reasonable principle of democracy, and more!
Because that’s the reality. There’s a reason that every problem about Obamacare that McConnell bemoans, his plan makes worse. What the republicans in congress want is not better universal health care coverage, or more right-wing universal health care coverage. You can’t get further to the right of Obamacare and still get universal health care coverage (this NYT piece has some useful info on that). What they want no universal health care coverage. They don’t want the government involved in healthcare. They want low taxes (especially on the rich), low services, and a government you can drown in the bathtub.
But the whole reason they weren’t upfront with this desire is that it’s a political non-starter. 69% of Americans support preventing insurance companies from denying coverage due to a person’s medical history. Support for the senate health care plan is polling at 12%. Brings to mind that old poll that compared support for Congress with support for traffic jams, cockroaches, and Nickelback. People hate the republican plan, because it’s a terrible plan - a plan which will leave those who need it most without coverage in order to pad the pockets of those who are already rich. The kind of bill that ought to get Mitch McConnell visited by a trio of ghosts.
So they have a few choices.
Push the repeal through. It’s understandable that certain congressmen are hesitant about this, given the absolutely miserable polling of the bill, the fact that there is not a single state in the country where this bill has majority support. It’s slightly less understandable that nobody has stood up and said, “Wait, this is evil and utterly spits in the face of the principles of a democracy. We can’t do this.” This really is as clear a vindication of Pelosi’s “You have to pass the bill to find out what’s in it” statement as you’ll ever see: as the actual effects of a repeal became clear to people, it became a lot harder to blindly support repealing it. As the atlantic piece I linked up top says, “In contrast, Fox News viewers […] weren’t merely misled about health-care tradeoffs. They were told a bunch of crazy nonsense.”
Not repeal Obamacare. This is also kind of a non-starter. Repealing Obamacare has been their #1 talking point for the past 8 years. This has been the drum they have been beating literally non-stop. It’s given them control of every branch of government. For them to step back now and say, “Well, we lied, we’re not going to do the single thing we’ve promised non-stop we would do,”… The political backlash would be intense even if it weren’t for the fact that the right-wing media like Breitbart and FOX now essentially runs the party, and would immediately call for (and probably get) the heads of various republicans in congress, Kathy Griffin style. Then they would have to explain the reason they can’t do it, and not only are there not that many plausible reasons, there are no plausible reasons that don’t just exacerbate the problem and kick the can further down the road. Sure, you could blame it on the RINOs and say, “If we primary Collins and Murkowski and get real conservatives instead, we can get this done,” but then two to six years later, when Collins and Murkowski have been replaced by nuts of the Gianforte or LePage variety, you run into the exact same problem again: the bill is awful, everyone hates it, and you’re stuck back at this juncture wondering what to do.
Replace Obamacare with a healthcare plan that actually is an improvement. This is not really possible for the republican party. Their philosophical position doesn’t really allow for it. Building a UHC policy further to the right of Obamacare just does not work. You can’t do it. And they can’t go further to the left after spending eight years screaming about the government takeover of healthcare, nor do they seem to want to. Their base would ruin them, their media outlets would savage them, and it’s just not going to happen.
So basically, they’re stuck. There’s really no good option here. This is why you shouldn’t build your campaign on a laundry list of insane and obscene lies. Sooner or later, you might have to fulfill those promises, and then the shit is gonna hit the fan.
Because:
the Bill in Congress that Trump could use to repeal and replace was Ryan’s. It is essential a re-redistribution of wealth via tax cuts, undoing tha taxes imposed by Obamacare.
many other Republicans want a very different approach. BUT, to my knowledge, this bill was structured to fit into the Budget, so it would qualify to be passed under Reconciliation, only needing 51 votes. Trump went with Ryan’s because it worked for Ryan, it could fit in the budget, and Trump is clueless about healthcare policy.
so there is actually very little room to negotiate and change the fundamental structure of the bill which is why GOP leadership have been playing hid and seek with it, and also why the CBO scores have kept showing >20 million uninsured over 10 years.
Navigating politics and congressional procedure is incredibly difficult - look at Obamacare itself. So even with GOP majorities this stuff is tough.
Of course, this might be a little less godawful if instead of pumping hundreds of billions of dollars into tax cuts, they instead put that money towards shoring up Medicaid, or subsidies. But they didn’t. Because they didn’t want to. Because the goal was never “better healthcare”.
Okay, so why not avert all that and just repeal without replacement? That was what many in the thread I linked were sure would happen.
Because not enough Republicans for some reason have figured out that they could pass a bill naming a post office and call it the “100% Repeal Of Obamacare Act,” Trump could declare Obamacare repealed, and the base would buy it no matter what fake news or their HMO had to say about it. The base doesn’t give a shit about their own healthcare, you could tell them if they stick an ice pick in their eye Obamacare would be repealed and they’d do it.
The technical reason? They can’t get to 51 because of 2 or 3 moderates. Satisfy the moderates, you lose at least 2 or 3 hard liners.
Smart money is on “because that would be even worse”. Nobody wants to go back to 2006 healthcare.
Because they all want to get re-elected. What changed is that, as Pelosi predicted, people came to support ACA once they found out through experience what it really is, not what Fox said it was.
There may also be an element of conscience involved, but that’s speculative.
I don’t think they have the votes in the Senate to do a complete repeal, because of the different Senate rules for votes on financial and regulatory measures.
The ACA was a mixture of regulatory and financial measures.
The Republicans can repeal the financial measures with a bare 51 vote in the Senate, if it qualifies as a budget reconciliation measure. But that leaves the regulatory measures intact.
They need 60 votes to repeal ACA entirely, and no way any Democratic senators will vote that way.
That thread was immediately after the election. Most sane people were properly shellshocked at that time. Now it is apparent that Republicans are vaguely aware of the needs of the people they represent, and could not just take away health coverage and leave it like that. The closest they came was trying to rush that senate bill through before anyone knew what was in it, and they can count their lucky stars that it didn’t go. People whose votes they count on would have been pissed. (But they tried anyway, that’s a crazy thing. What kind of reaction were they expecting??)
Obamacare was largely designed by (moderate) Republicans all along. Their opposition to it was just part of their Make Americans hate the government; Make Americans hate Obama agenda.
For anyone who thinks differently, note that they had eight (8) years to design a better system, but did absolutely nothing about it until 2017 when their leaders threw jumbled legislation together with little thought or concern. (Obamacare has always been in need of improvements, but throughout the Obama Administration the GOP, with its legislative pinch-hold, obstinately refused to entertain any thought of allowing it to be amended.)
The only consistent GOP agendum is tax cuts for the rich. The entire purpose of Trumpcare (or Ryancare) is to transfer wealth from the middle class, the poor, the young, and the sickly to the rich, the very rich, the top 0.1% and the top 0.01%.
Trumpcare(*) would surely show us all exactly what present-day Republicans have become … if there was anyone left whose mind wasn’t already made up.
(* - It may seem silly to call it Trumpcare since even he knows how “mean” it is. But he has to dance with them that brought him.)
The real answer is that while Republicans want Obamacare to be repealed and replaced, the different wings of the party want different types of replacement. Conservatives like Ted Cruz and Rand Paul want to pretty much eviscerate the additional subsidy funding, while liberal Republicans like Susan Collins, and to an extent other Republicans in Medicaid expansion states, want to keep that funding so that they don’t have to face voters who have had their (free, government provided) healthcare taken from them.
In short, there is no majority support for ANY path forward, including continuing Obamacare.
I’ve also seen it called “Don T. Care”. Which works on multiple levels.
Excellent Long Answer from Budget Player Cadet.
Here’s the short and to the point of the title question (A lot of people thought ACA repeal was a no brainer done deal when Trump won. What happened?):
What DIDN’T happen is the crux of the matter. What DIDN’T happen, was that for eight years, no Republican ever even once, put any thought or effort into thinking through the process.
No prep work, meant that they were all caught flatfooted when to their intense surprise, they won control of the House, the Senate, and the Presidency all at the same time, for the first time since 2003-2005, under Bush.
No one noticed back then, that they failed to do ANYTHING that they’d been harping on to get elected either, because they hadn’t prepared any legislation then, either.
Way back then, the Republicans had promised Tort Reform to fix Health care, and once in power, dropped the subject. They’d promised to “fix” the fact that laws they passed didn’t apply to them, too, and refused to even attempt to change that either.
Republicans as a party aren’t really in to the whole think-things-through-first-and-then-act deal.
A lot of people thought Trump would never get elected. What happened?
Short answer to the OP’s question: No one knew that healthcare was so complicated.
I’m beginning to doubt the predictive ability of the SDMB.
No one that had actually addressed it, anyway.
Sure. That’s why Trump’s comment (which I was parodying) is so nonsensical. However, I doubt there are many Republicans in Congress who did give it much thought until it came time for them to craft an ACA alternative. So, Trump was basically correct, if we apply his comment to Republicans.
The GOP used to be about spending less and smaller government. No longer. They just want the money spent on different things than the Dems do.
Otherwise, your post is spot on.