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I seem to recall that Republicans voted to amend or repeal Obamacare dozens of times when Obama was president. It was a meme that they had so many better ideas about health care. They seemed to be confident and full of ideas, and had no problem delivering many of them to the President's desk. But, even though they have a friendlier President who was interested in health reform, now House Speaker Paul Ryan just cancelled a vote and conceded:

We're going to be living with Obamacare for the forseeable future

What happened? Why couldn't they pass a single one of their many, previously-successful proposals under a Republican president?

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    Ever heard of the dog who caught his own tail? – Ian Mar 27 '17 at 16:57
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    It's easier to be against something than for something and seeing what they were voting for this time (for millions uninsured & for more tax breaks which would not help individuals & small business) they didn't get enough support. – Mr. Kennedy Mar 29 '17 at 23:29
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    "It is easier to be critical than correct" -- Benjamin Disraeli – RBarryYoung Mar 30 '17 at 21:39
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    It is safer to vote on something that will never pass.... – user7693 Mar 31 '17 at 17:05
  • If Wikipedia is correct, they only sent it to President Obama's desk once (H.R.3762, which he vetoed). However, various repeals passed the House 54 times... as of March 2014. It's probably much more now. – Matthew Flaschen Jul 30 '17 at 9:51
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Why couldn't they pass a single one of their many, previously-successful proposals under a Republican president?

The simple answer is that you're measuring "successful" by how many votes were garnered in Congress. This is a slippery measure.

Voting to repeal the Affordable Care Act when the sitting President (Obama) is guaranteed to veto your repeal is merely a political gesture. It says, "I abdicate responsibility for any negative effects of Obamacare, because I voted to repeal it!"

When the President (Trump) is actually likely to pass your repeal, then you can no longer just make political statements; you must consider the consequences more carefully.


This answer purposely does not address the question of whether a repeal would be a good thing or a bad thing in terms of economic consequences.

I only refer to the perceived consequences for political careers, as perceived by members of Congress. They may or may not even perceive them correctly; I am not judging that either.


Put another way:

Voting for a bill to repeal Obamacare that is subsequently approved by the President, puts Congress "on the hook" for the consequences of the repeal.

Voting for a repeal that is vetoed takes Congress off the hook for any negative effects of the Affordable Care Act.

One involves abdicating responsibility, the other involves assuming responsibility for potentially negative consequences.

That's politics for you.

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    Was going to add my own answer, but really it's just an adjunct to this. Republicans have verified this is accurate: when quizzed about the failure, Joe Barton said "We knew the president, if we could get a repeal bill to his desk, would almost certainly veto it. This time we knew if it got to the president’s desk it would be signed.” In other words, the demainds to repeal Obamacare were only ever symbolic - via talkingpointsmemo.com/dc/leadership-pulls-obamacare-repeal – Bob Tway Mar 27 '17 at 14:25
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    @JDoe - Party unity. They were all on the same 'The ACA is bad' bandwagon, which was a uniting factor until they were actually in a position to change it. Now they have to face the fact that they all have different reasons for hating it, and different ideas about replacement, and a number of them have realized that if they just throw it out they'll be hammering their supporters, and therefore slitting their own throats (politically speaking). – Michael Kohne Mar 27 '17 at 19:18
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    @JDoe - It's symbolic of not liking Obamacare. Unfortunately, that doesn't mean that they know a cost-effective way to reform it. I.E. It's much easier to say "You should fix this, because it is bad and expensive" than to fix it yourself, just like it is outside of politics. – EvSunWoodard Mar 27 '17 at 20:17
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    @JDoe - And yet here we are discussing the inherent value of voting at least 60 times. So, clearly some people are convinced they were serious. It's also possible that they didn't do significant research into what they would replace it with given the chance, especially if they thought Hillary would win. Therefore, they may have been blindsided by having to come up with a suitable answer. – EvSunWoodard Mar 27 '17 at 20:38
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    What I've gained from all these answers is that Republicans who opposed the ACA are like a person who's angry about being stuck at a stoplight. Yeah, the situation is frustrating, but any attempts you make to fix it, as someone who's not well-versed in the topic and working without consultative help, are really only going to make everything worse, 99.9% of the time. The major difference is that your Congressman has a lot more power than your drunk, angry uncle. – Papayaman1000 Mar 29 '17 at 10:11
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It's not that the Republicans couldn't pass the AHCA, but that they didn't want to.

It is difficult to just repeal the ACA, which is why the Republicans went from a repeal-only to a repeal-and-replace approach. The AHCA was what Trump and Ryan wanted to use as replacement, but it was widely unpopular among Republican and Democratic politicians as well as the US population in general.

From the NYT article you linked:

House Republican leaders, facing a revolt among conservatives and moderates in their ranks, pulled legislation to repeal the Affordable Care Act

The unpopularity of the Republican health care bill has been shown in a number of polls:

The results of six polls, with the average being 30% support/favorable, 47% oppose/unfavorable and a net support of -16

It is also easy to agree to vote to repeal when you know that you can't. Those previous votes were not held to actually change policy, but to send out a signal that all Republicans disapprove of the Affordable Care Act. But not all Republicans – and especially their voters – approve of the new plan, so voting for it is a lot more difficult.

The party was also divided on why they dislike the new bill. The Freedom Caucus thought that the bill did not go far enough:

More conservative members, led by the House Freedom Caucus, were angry that the bill left some of the Affordable Care Act’s insurance regulations in place. Those regulations, they suggested, would keep premiums from falling further ― although the precise relationship between each of these regulations and actual premiums is murky.

And other Republicans thought that the bill went too far:

More moderate members, many of them from Democratic-leaning states and states that used Affordable Care Act money to expand Medicaid, worried that the bill would take away insurance coverage from too many people ― and that, if premiums really did come down, they would do so only by increasing out-of-pocket costs for people who held on to their coverage.

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    You cannot just repeal the ACA Actually you absolutely can. Many don't want to do that (though some, especially in the freedom caucus, do), but that is only because they believe it should be a simultaneous repeal and replace, not because there is anything actually blocking them. Whats funny is that you seem to make this point in your first sentence but then you directly contradict yourself in the second sentence. – David Grinberg Mar 25 '17 at 0:42
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    @DavidGrinberg The specific mechanism that republicans are using to alter the ACA, the budget reconciliation process, which avoids the senate filibuster, does not allow a full repeal. – isaacg Mar 25 '17 at 3:42
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    @isaacg It does not need to be repealed via reconciliation. If they want (and I totally realize that this will never happen because it would be bad politically for Rs) they can create a new 1 line bill that says ACA is repealed. – David Grinberg Mar 25 '17 at 5:28
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    @DavidGrinberg It's not just that it would be "bad politically" for them. There are only 52 Republican Senators, which is not enough to overcome a filibuster. Unless they pass it via budget reconciliation, it they cannot pass it at all. – Avi Mar 25 '17 at 6:30
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    @DavidGrinberg no, as isaacg points out, they couldn't just repeal. They didn't have the votes for that. They needed democrats for a full repeal. This was a hail-mary type play in hopes of crippling the ACA via a budgetary move where they wouldn't need a super majority. – user1530 Mar 25 '17 at 19:03
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@tim has given a good answer in terms of the specific vote. However it's also worth looking at the reason why the Republicans couldn't get behind a replacement.

The problem that the Republicans face is that the key elements of Obamacare were actually Republican ideas. This paper from the Heritage Foundation outlines the main points which were later introduced into Obamacare. When Mitt Romney was Governor of Massachusetts he introduced a statewide health law based on these same ideas. (Edit: added link to list of similarities and differences)

When President Obama proposed the Affordable Care Act the Republican party was faced with a difficult choice. They could have supported the ACA while pointing out that Obama had merely pinched their best ideas, but this would have meant handing Obama a major political victory and an important historical legacy. Since they hated Obama they couldn't stomach that, so instead they decided to airbrush out their own history and position themselves in opposition. They managed to make hatred of Obamacare a major mobilising point for their base, but now they have the opportunity to replace Obamacare they are in a bind: they can't create the scheme they had planned because it would be too obviously Obamacare with a red paint job, but they don't have any new ideas to replace it.

Trump isn't helping. He promised to replace the "broken" and "unconstitutional" Obamacare, but never got around to saying what he would replace it with. Then he discovered (to his immense surprise) that it's complicated.

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    A lot of this is opinion and conjecture about why Republicans didn't support the ACA. It also neglects to mention that Obama had a supermajority and didn't need any Republican votes, so no Republican input was included. And saying that Romney's plan was widely accepted by the GOP in general is false. It's also false that the core Obamacare ideas were derived from a Heritage Foundation paper – Machavity Mar 26 '17 at 1:20
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    @Machavity - It is a complete untruth that "no Republican input was included". There was whole year of crafting ACA, during which Republican input in particular was heavily sought (in hopes of getting some votes), much of which is in the bill today. The most notable instance of this was Section 1233 of bill HR 3200, put in at the request of former surgeon Republican representative Charles Boustany. This provision then got decried by Republicans as "death panels" – T.E.D. Mar 27 '17 at 16:03
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    @Machavity - This answer may include some speculation as to why no Republicans voted for it, but whatever the real reason may be, it was objectively not because they weren't courted or negotiated with. They were, heavily. – T.E.D. Mar 27 '17 at 16:04
  • @Machavity, I never said that Obamacare "was derived" from the HF paper, I just used it as one of the examples to show that the same basic concepts were part of mainstream Republican thought. – Paul Johnson Apr 2 '17 at 16:44
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Some good ideas already, but I wanted to add some. From general to specific:

  • It is easier to join a disagreement than to agree on something. If a road has a speed limit of 80 km/h, Alice can think that the speed limit should be 100 km/h, Bob that it should be 120 km/h, and Carol that it should be 50 km/h. While they are all against the current speed limit, they likely would not be able to reach an agreement about which the new speed limit should be.

  • Unless it is a complete disaster, it is easier to fight such a law before it is implemented. Once it begins working, its benefits become more evident to the public (at least to the part who directly benefits from it) and it creates interests(stakeholders) that move against repeal/drastic changes. It is easier to sell the idea that "Obamacare = death panel" before people gets healthcare coverage (and in some cases, services that they would not have been able to fund themselves) thanks to the Obamacare.

  • From the previous point, you no longer can simply "repeal" it but you must offer (or claim to offer) some alternative to what it provides.

  • From the beginning criticism against the ACA was very strongly worded (remember the "death-panels"?) and became a core tenet of the Republican party (with the added pressure of the Tea Party). Moderate republicans that maybe could have been ok with it had no option but to be silent or lose all support (remember that some republican governors had similar systems in place). Now there is no need to fight Obama (except for Trump), so there is less external pressure.

  • This bill has been rushed. ACA took like 18 months to pass (IIRC). This was intended to pass in weeks. As stated above, consensus in favor of something is not that easy, and simply there was no time to build a consensus, even if it were possible.

  • The bill is unpopular. As stated above, people has come to see benefits in the ACA, and they do not want them taken away. Worse, the most hit by the new law seems to be mostly republican held areas, which could mean a very heavy electoral cost to any representative supporting it.

  • The bill is simply not finished. While someone took pride that it was short (as if it were of any value to the general public), any question about undecided points was swept under the rug of the "third bucket". And, despite evidence of the contrary, most representatives are smart enough to see that if these problematic details are in the third bucket, the third bucket will simply never come to pass. It is like preparing a budget by deciding what to spend the money on but without telling how the money will get earned in the first place.

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    Building on your first and second points: Opinion polls have consistently shown more support for most (all?) provisions of Obamacare than for "Obamacare" as a package. – Bobson Mar 26 '17 at 2:00
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    @Mark and yet, that's the key piece that keeps the whole scaffold from collapsing. I suspect there's a subset of the GOP that would be happy to simply replace the mandate with a continuous coverage requirement (which is meant to accomplish the same goal), but the reality is that that's just a shellgame that shifts the penalty on the uninsured from being government revenue to insurance company revenue. And a giveaway that naked wouldn't be too popular either. – LessPop_MoreFizz Mar 26 '17 at 6:51
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    FYI "unpopular" is definitely a word. "Impopular" I've never heard of before. It might be legit, but I'm imsure about it. – Todd Wilcox Mar 26 '17 at 13:19
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    Rushed? The Republicans hat years to come up with an alternative. And Trump promised last year that he already had an alternative. So what changed? – Martin Schröder Mar 27 '17 at 13:49
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    @MartinSchröder - ah, yes - last year's "solutions". Errrrrm - well, y'see - uh...those were verbal campaign promises, which aren't worth the paper they're not printed on. This year's solution, or next year's, or "someday's", will have to be actual legislation, which has to be voted on by real politicians who have a deep-seated desire to hang on to their phoney-baloney jobs. – Bob Jarvis Mar 28 '17 at 2:31
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Sixty senators must vote to close a filibuster, the Republican party currently only has 52. Despite the fact that Republicans control Congress and the White House the Senate Democrats could filibuster any legislation that aims to repeal Obamacare.

Therefore, Republicans aim to repeal Obamacare through a legislative process known as budget reconciliation.

"Reconciliation is a legislative process used in the United States Senate when confronted with a controversial and heavily debated budget item. It is a way to get around the required 60 votes necessary to kill the minority party’s filibuster. The process of reconciliation was first introduced in the Senate in 1974. It streamlines and limits debate and the process of amending the bill, and only requires a simple majority of 51 votes. Reconciliation also exists in the House of Representatives, but has less significance or impact on the way the House operates since the House has a committee that passes rules that would limit debate and the amendment process." https://www.votetocracy.com/blog/what-is-reconciliation

One of the rules to budget reconciliation is that the bill must be a direct, measurable effect on federal spending. Whether or not it conforms to the rules is ultimately judged by the Senate parliamentarian, so Republicans cannot simply add whatever they please to the bill. A 100% repeal does not conform to the rules of budget reconciliation, so its not possible this route.

This is how Republicans got Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 passed, although it was ultimately vetoed by President Obama.

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When Obama was president, Republicans knew that their votes to repeal would be vetoed. They were merely grandstanding. Now that they have power, they have responsibility. Solving a problem is much harder than complaining about it.

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    Identical to Wildcard's earlier answer. – DevSolar Mar 27 '17 at 8:45
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It's true that the failure to repeal has many reasons, but many do not have much to do with the central paradox that J Doe raised: how the calculus changed after achieving greater power. Others have postulated what I think is correct, but we can actually go to an insider source. What better authority to defer to than the dean of the Texas congressional delegation, proud member of the Tea Party Caucus, the man who apologized to BP for their oil spill, Republican Joe Barton:

“Sometimes you’re playing Fantasy Football and sometimes you’re in the real game,” he said. “We knew the president, if we could get a repeal bill to his desk, would almost certainly veto it. This time we knew if it got to the president’s desk it would be signed.”

You gotta admire the guy's honesty!

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