Opinion: Beware of what you promise: why Trumpcare failed

By Arthur Garrison
Faculty Contributor

President Donald Trump discusses replacing the ACA with lawmakers.
– Twitter Account for Vice President Mike Pence

Political rhetoric matters. Political narratives matter. Both create limits on what can be done when focusing shifts from rhetoric and narratives to policymaking.

After months of wrangling, the Republicans failed to deliver on a foundational political rhetorical promise – repeal and replace the Affordable Care Act. After the House barely passed a bill, the Senate Republicans failed to pass a watered down version of a bill repeal the ACA.

For more than seven years, the Republicans built their entire political existence and purpose on opposing the passage of the ACA and then promising to repeal it “root and branch.” Over the past seven years the political rhetoric had borne fruit. The Republicans took over the House in 2010 and the Senate in 2014, and in 2016 the presidency. All taken with the singular unifying promise of repeal and replace.

When the Republicans owned the House and Senate, they were perfectly unified in repeal and replace. They passed bill after bill that repealed the ACA when Obama was president, knowing it would be vetoed. Therein lay another key point: They knew the repeal bills meant nothing and would cost them nothing.

But now they have all three branches and now repeal and replace had political consequences. After more than seven years of rhetoric at no cost, the Republicans had to face a harsh reality – the ACA had a strong support base that resisted its repeal. But more importantly, it became clear that after seven years the Republicans only had rhetoric on repeal. They had no real legislation to repeal and had even less on replace.

In desire for votes, the Republicans needed votes from conservative Democrats and found none. Why? Because political rhetoric has consequences.

Since the Republicans had built their political success on destroying the signature accomplishment of the Democrats, not fixing the details of it, the Democrats held firm in offering nothing, leaving the Republicans to do what they promised alone.

Had the Republicans said, “We will fix and repair the ACA,” they would have had bipartisan support. But the true believers of the Republican Party would have revolted at such an approach.

The presence of the true believers raises another point. When it came to the ACA, the Republicans were only united on the rhetoric. Once actual policy and legislative drafting replaced political rhetoric, the Republicans discovered that many of their membership actually liked parts of the ACA.

In both the House and Senate, clean bills that simply repealed the ACA failed. The true believers believed in repeal and maybe replace but en mass the Congressional Republicans did not, because repeal and replace was a train to election victory over Obama not passable legislative policy.

Here is the bottom line: Republicans built their brand on the back of President Obama per se and specifically on its opposition to the ACA. Once they took all three branches of government, the Democrats would provide no aid because there was no political room for bipartisan legislation. Republican rhetoric was repeal and replace. Politically, they could pursue no less.

The Democrats had lost the House and Senate over the ACA and they were not going to give aid to anything with the label repeal. The Republicans were on their own.

Once in power the Republicans discovered the hard political reality that ACA and its Medicare expansion funding had support within their white rural, suburban, middle-America constituency. A constituency that made clear that the ACA provided financial support in dealing with the opium addiction epidemic it was suffering from.

Once in power, the Republicans discovered that people who are given healthcare were not inclined to having it taken away.