The GOP Effort to Repeal and Replace Obamacare Isn't Going Very Well
New polls show the health law's popularity rising as Republicans struggle to come up with a plan.
Republicans have finally figured out how to do something that President Obama never managed: make Obamacare more popular. The trick, it seems, is threatening to repeal it.
Throughout Obama's presidency, the health law struggled in the court of public opinion, with nearly every poll showing that more people opposed the law than supported it. Now several recent polls show the law rising in popularity as Republicans begin the process of unwinding it.
Approval ratings for the health law rose from 41 percent at the beginning of the year to 47 percent at the end of January, according to a Morning Consult poll released this morning. That tracks with an NBC News/Wall Street Journal poll released earlier this month, which found that 45 percent of the public thinks that the law is a good idea, while just 41 percent think it is a bad idea. Similarly, a Fox News poll taken this month found that 50 percent of the public views the law favorably, while 46 percent view it unfavorably.
These numbers are relatively close, and they do not indicate that the law has suddenly become wildly popular. But they do suggest that the public is shifting its opinion about the law as the GOP repeal effort is getting underway.
The reason, I suspect, is that Republicans have never sold a clear and distinct vision of what the nation's health care system should look like. And now that the GOP is in a position to repeal the law, poll respondents are not treating the question as whether they like or dislike Obamacare in the abstract, but whether they prefer it to the likely alternative—an alternative that Republicans have largely declined to present.
The problem for Republicans is that they do not have any consensus about what that alternative is. While some GOP legislators, like Kentucky Senator Rand Paul, have proposed replacement plans in vary degrees of specificity, the party as a whole has never united around a replacement framework, much less specific legislation. And it has never made an extended argument in favor of a clearly defined alternative. So far, then, the effort to repeal and replace the law has mostly demonstrated how hard the task will be, and how unprepared congressional Republicans are to make good on a promise they have been making for six years.
Already, the party has blown its own project deadlines. Eliminating the law and setting up a different system was supposed to be the Republican majority's top legislative priority for 2017, but that effort has already slowed to a crawl. And so a budget resolution passed by both the House and the Senate at the beginning of the month set January 27th as the date by which key committees were supposed to have finished drawing up replacement legislation. This committee level work is a necessary first step towards repeal and replace. It must happen before any health care legislation can become law. But not only is this work not complete, it has yet to even begin. Republicans, in other words, have not even managed to take a basic first step in drawing up legislative plans.
In private, Republican legislators seem totally confused about the direction of the repeal effort. At a retreat for GOP lawmakers last week, party leadership laid out a timeline for repeal, but provided no specifics about what the legislation would look like. One GOP lawmaker attending a session that was supposed to lay out the repeal plan told The Washington Post's Mike DeBonis, "There have been zero specific offered and it is fascinating to see the lack of clarity on this issue." The Post also obtained audio of a meeting in which Republican legislators discussed replacement options, but came to no consensus, and worried about the policy and political consequences of any replacement plan.
The disarray surrounding the replacement effort has already led some conservative pundits to call for the GOP to punt on repeal. As if on cue, two Republican senators recently introduced a replacement that would allow states to opt in or out of its major components at nearly the same funding levels as exist now. It is not a plan to replace Obamacare so much as a way of guaranteeing that the law would remain in effect in large parts of the country forever, with generous federal support. It is practically the definition of a punt.
Republicans are preparing to punt because they do not have a plan they can all get behind. And the reason they do not have a plan now is because they did not make the effort to craft a plan during the years in which they were promising to repeal Obamacare and install a replacement.
Doing so would no doubt have been difficult, because it would have required Republicans to debate the merits of various alternative policy mechanisms, to accept the tradeoffs that come with any policy overhaul, and then to make the case to the public that their vision was preferable to Obamacare's. Republicans never developed their own unified vision, and so had nothing to sell to the public when given the opportunity to mind the store. That lack of preparation is why the effort to repeal and replace the law is now stalling.
Health policy is by nature politically treacherous, and it requires a willingness to engage in complex policy planning. Democrats spent nearly two decades developing the policy framework that led to Obamacare, and even that didn't generate widespread support. But the general consensus amongst Democratic politicians meant that the party had something to work with when the opportunity arose.
The polling from the Obama administration provides clear evidence that the public does not particularly care for Obamacare. But now that the public is being asked to choose between Obamacare and some mysterious alternative that even Republicans themselves cannot describe with real clarity, public opinion on the health law is turning around. (Indeed, it is a testament to the law's considerable weaknesses that so much of the public remains opposed to it even without any alternative at the ready.) It is possible that, given an opportunity, the public might have rallied around an alternative. But Republicans, who have been unable to rally around any plan themselves, gave them nothing to get behind.
The entire episode is a lesson for both parties about ignoring the complexities of legislative detail in favor of easy campaign rhetoric. For too long, Republicans treated the repeal and replacement of Obamacare as an empty political slogan rather than as a substantive policy goal. That can sometimes be an effective tactic in the short term. But in the long run, as Republicans are learning, it only sets you up for both policy and political failure.
