Why couldn't Republicans who voted to repeal Obamacare so many times under Obama do it under a Republican president?

Question

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?

Answer 1

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.

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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.

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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.

Answer 2

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:

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.

Answer 3

@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.

Answer 4

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.

Answer 5

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.

Answer 6

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.

Answer 7

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!