For the six years they ran the House before President Donald Trump arrived on the scene, Republicans voted repeatedly -- more than 50 times -- to either fully repeal, defund or in some way undermine Obamacare. On Capitol Hill or back home, they railed against the law, pledging to gut it -- if voters would only hand them the fillet knife.
And then, after some convincing, voters did.
First, in 2014, Republicans won a Senate majority. Two years later, they reclaimed the White House. But, after months of machinations and negotiations, PowerPoint presentations
and strategic "buckets,"
their odds of leveling the longtime bogeyman are growing longer. There are still twists and turns in this story, but if the Republican health care bill fails, it will be as much a function of repeated tactical blunders as legitimate concerns about legislation that could add 22 million to the ranks of the uninsured over the next decade.
The simple promise, launched years ago, to "repeal Obamacare" was the first, crucial error. Not because it wasn't a winning message, but because it was, in a way, too good. It was simple and clear. But there was no open reckoning with the downside and little apparent planning for the day it became possible. Clawing back welfare programs is never politically popular. For those who insist on trying, common sense says plowing ahead without a stress-tested alternative will only complicate matters.
The absence of a viable replacement -- "repeal and delay"
never took -- ultimately gave way to the American Health Care Act in the House, which passed in May after a false start weeks earlier, and the Senate's Better Care Reconciliation Act. The latter is stalled in the upper chamber and, like the House measure, remarkably unpopular in public polling. If senators do manage to rally around a bill, that legislation would still have to be reconciled with what passed through the House.
Access vs. coverage
A look back at recent comments from Republican officials on the front lines of the fight offers some telling suggestions. At the root is a very simple matter of conservative orthodoxy and the possibility that Republicans, newly empowered by Trump's election, appear to have read into his win a broader mandate than voters actually offered. That shouldn't come as a shock. Both parties tend to make too much of their presidential fortunes.
But Republicans on Capitol Hill set to work in 2017 with little more than a series of talking points -- the kind that seemed more in line with Reagan-style convervatism than Trumpism. Right off the bat, the idea of providing better access to medical care, which would be shifted back in the direction of the open market, emerged as a central theme of their pitch.
Health and Human Services Secretary Tom Price, during his confirmation hearings in January, telegraphed the strategy. Skirting skeptical Democrats' cross-examinations, he promised to work with Congress to assure "every single American has access to affordable coverage." During an earlier round he said all Americans should "have the opportunity to gain access" to it.
But access does not equal coverage. Asked on CBS's "Face the Nation" how many people might lose coverage under the House plan, Speaker Paul Ryan said the number of uninsured would likely rise, but sought to frame it as a symptom of well-exercised "individual freedom."
"I can't answer that question. It's up to people," he said
. "People are going to do what they want to do with their lives because we believe in individual freedom in this country."
When the nonpartisan Congressional Budget Office's score arrived, the number was staggering. Projected out over a decade, 24 million people
faced losing insurance coverage. Obamacare supporters, who had objected early on to the GOP logic and argued that "access" to an insurance policy does not guarantee it will be affordable or cover needed care, took the news as vindication.
Facing pressure from both moderates jolted by a fierce opposition and hardliners who still preferred full repeal, Ryan pulled the initial bill. A tweaked version designed to convert Republican holdouts would pass, narrowly, about a month later.
Over time, Republicans began to back off the "access" proposition, but never seemed to agree on a new direction.
Senate Republicans promptly trashed the House legislation and set about writing their own.
But there was another problem brewing. Congressional GOP messaging about what the final product would deliver ran up most rudely not against Democrats' objections, or protesters at town hall meetings, but the most powerful Republican of them all: the President. Throughout his campaign, Trump promised, vaguely but consistently, that his health care plan would cover more people and -- crucially now -- not mess with Medicaid.
"We're going to have insurance for everybody," he told The Washington Post
days before taking office in January. "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us."
The realities of governing -- and doing it in concert with Republican lawmakers -- always suggested otherwise, and the House negotiations illustrated that it was plainly impossible. Not long after celebrating the House bill's passage alongside Ryan and the GOP conference, Trump doubled back to describe the legislation as "mean."
All sales final
Around that time, Majority Leader Mitch McConnell gathered a Senate working to group to draw up a new bill. The process was conducted in secret, and all the voices in the room belonged to white men
. Republicans were no longer seeking to sell their massive planned remaking of the American health care system to the public. Instead, the focus narrowed to 52 senators, of which McConnell needed the support of at least 50 for clear the most immediate hurdle.
Not long after receiving a CBO score in line with the House bill, and amid internal backlash over measures to restructure (and effectively scale back) Medicaid, Senate leadership scrapped a vote
tentatively scheduled for before the July Fourth recess. The message to voters, with lawmakers now back home and either avoiding constituents or straining to answer their questions, is increasingly murky -- and hamstrung by past sloganeering.
One of the few Republican senators to hold an open town hall during the break, Kansas's Jerry Moran, explained to a crowd on Thursday
that he ultimately wanted a bill that would, among other things, drive down premiums and protect patients with preexisting conditions.
"That ought to be the goal -- repair, replace, whatever the words are people use today," he said. "The question is, (is) there something that can be done, and I await that conclusion."