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Another reason that Republicans haven't spent much time developing a replacement plan is that any time and effort spent on replace is time and effort not spent on repeal. "There's been a sense amongst Republicans that if you put up your own proposal, you complicate the case against Obamacare, or you distract from the case against it," says Levin.
Repeal is intellectually, if not legislatively, easy. Replace is hard. "Republicans have had a hard time working on health care issues for a while," says Heather Higgins, the founder of the Repeal Coalition."There's a segment on the right that does not want to talk about any kind of replace or reform of the system."
In background conversations, Republican aides agree. "There's just no appetite to lay out an entirely new agenda of ideas," a House GOP staffer told me in October. Instead, the focus is on "expanding existing criticism" and "continuing to bludgeon the administration" over problems with the current law. "If Republicans were interested in fixing health care, they would have been talking about it much earlier," the staffer said. "They weren't."
Distraction, Disunity, and Dissent
It's not just the distraction that worries Republicans. It's the inevitable disunity involved in trying to get behind a single plan. And the saga that led to the 16-day government shutdown in October illustrates how difficult it is to hold the GOP coalition together even over the easy part.
Following the initial January 2011 vote to repeal the Affordable Care Act, a few conservative activists with inspired imaginations argued that the votes actually presented a plausible path to full repeal. But two years and dozens of repeal votes later, it was clear that the votes had become a strictly symbolic ritual.
Activists on the right wanted action-and with October looming, they were running out of time to prevent ObamaÂcare from becoming a potentially permanent fixture in American law. As the opening of the exchanges grew closer, a small band of conservative activists and legislators, many of whom were relatively new in Washington, began to push a strategy they said offered the last, best chance of taking the law down before its major provisions went into effect. Their idea was to strangle the law at birth by cutting off its funding in the continuing resolution for funding government that needed to be passed by October 1.
If President Obama and Senate Democrats did not agree to pass a funding bill that stripped the health law of financial support, then House Republicans would refuse to play along, and the government, lacking congressionally approved funding, would enter shutdown mode. That was the leverage point: Obamacare goes down, or the government will close.
The argument from supporters of the defund push was that Obamacare was so unpopular a government shutdown would be blamed on Democrats for protecting their hated law. But the plan was contentious even among some of the most entrenched critics of Obamacare. Sen. Tom Coburn (R-Okla.), an outspoken opponent of the ACA, called the defund plan "dishonest" and "hype," telling The Washington Examiner in July that it was a "denial of reality" to think it would succeed. "I'd be leading the charge if I thought this would work," he said. "But it will not work."
Even within the repeal coalition, there was significant dissent. Those opposed to the plan pointed to the government shutdown under President Bill Clinton and House Speaker Newt Gingrich, which succeeded mostly in souring public opinion about the GOP. The same thing, they predicted, would happen again this time, with Republicans eventually being forced to pass a funding bill with few if any concessions. (Polls taken toward the end of summer provided more evidence: The public remained opposed to Obamacare, but it opposed shutting down the government to defund Obamacare even more.) More to the point, there was no possible way that the president or Senate Democrats would agree to defund the law.
Defund defenders responded by saying that any vote for the continuing resolution would be a vote in favor of the law. "Defund it, or own it," said Sen. Mike Lee (R-Utah), who along with Sen. Ted Cruz (R-Texas) helped lead the defund push, in a July floor speech. The defund camp was accusing fellow Republicans of selling out the conservative movement.
"This was a complete fiction by the defunders that they had a more conservative, radical, free-market position," says Grover Norquist, the influential head of Americans for Tax Reform. "No they didn't. All they had was the position that clearly made no sense strategically, invented by the guys who decided to invade Iraq. Step one: Invade Iraq. Step two, Iraq turns into Kansas." The defund push, Norquist says, made just as much sense. "Step one, demand the president give us his most precious achievement in life, Obamacare. Step two, he'll give it to us."
Norquist argues that worries that the law would become untouchable once implemented were mistaken. "They had this magical view that everyone was really going to love Obamacare," Norquist says. "Which makes you wonder why they were opposed to it so much if they thought everyone would love it."
By October 1, defunders had dug in their heels and the Republican leadership in the House agreed to go along with the plan. They passed a funding measure without money for Obamacare, the Senate refused to consider it, and the government shut down. Obamacare's exchanges opened for business. And rather than a public outcry for Democrats to reopen the government without funding the Affordable Care Act, polls showed that most Americans blamed Republicans. Indeed, the shutdown may have helped Obamacare, albeit temporarily: An NBC-Wall Street Journal poll published October 11 found that support for the health law had jumped seven points since the previous month.
The plan's critics saw the whole episode as a lost opportunity. "The challenge with the defund-only strategy was not only that it failed, but we spent two months not doing other things," says Norquist. "The defunders added nothing to the conversation. They detracted from the educational process of explaining how bad Obamacare is."