House Democrats have a theory for why Republicans failed spectacularly in their attempt to pass a new health care bill filled with longstanding Republican health care policy ideas.
Rep. Ron Kind (D-WI) said it’s because Congress already did so — way back in 2010. It’s now called Obamacare.
“They’re now realizing, maybe for the first time, that we took all of their best ideas and put it in the Affordable Care Act. And now they have nowhere else to go,” Kind said of congressional Republicans in an interview on Thursday afternoon.
Since Obamacare’s passage seven years ago, Republicans have made the politically expedient argument that it represented a great leftward leap into the socialist dark. That suggested pulling American health care back to “the center” would be an easy lift.
But the substance of the bill they so hate, Kind says, incorporated many of the solutions they themselves have long supported — competitive marketplaces, cost constraints, the individual mandate forcing patients to buy care.
That disconnect, Kind and other Democrats say, is what drove the catastrophe engulfing Republicans right now: They failed to wrestle with how to make good on their promises to dismantle a bill whose underlying policies include many of their key ideas.
“They’ve got their fingerprints all over the Affordable Care Act, whether they want to acknowledge it or not. And that’s getting to the heart of what’s going on today,” Kind says. “They disingenuously rejected the ideas they embraced for years merely because it became part of the Affordable Care Act. That’s the box they put themselves in. And so they’re stuck.”
One reason Republicans are so stuck on Obamacare repeal: Obamacare has GOP ideas
When President Obama kicked off the negotiations for Obamacare in 2009, he made a point of promising to seek out as many conservative policy ideas as possible. Ryan’s American Health Care Act was suddenly dropped without input from the vast majority of his own caucus — much less from Democrats.
The difference is reflected in the substance of their legislation. Democrats wound up accepting more than 200 amendments proposed by Republicans, mining originally conservative ideas to make their reforms work and reflect the center of American politics. After more than a year of negotiations, Obama held a marathon seven-hour “bipartisan summit” at the Blair House in which he talked through health care policy priorities with dozens of Republican senators.
"I know a lot of people view this as a partisan issue. But both parties have found areas where we agree," Obama said in 2010. "What we've ended up with is a proposal that's somewhere in the middle, one that incorporates the best from Democrats and Republicans, the best ideas."
Those ideas came in forms big and small. In 1993, as President Bill Clinton searched for a health care reform package to get behind, former Sen. John Chafee (R-RI) floated a proposal that would have standardized health care benefits across insurers and created an individual mandate to penalize those who did not purchase care. Senate Majority Leader Bob Dole (R-KS), as well as Sens. Orrin Hatch (R-UT) and Chuck Grassley (R-IA), were among the bill’s co-sponsors.
"You would find a great deal of similarity to provisions in the Affordable Care Act," Sheila Burke, Dole’s chief of staff in 1993, told PunditFact. "The guys were way ahead of the times!! Different crowd, different time, suffice it to say."
Even though the individual mandate is a central part of Obamacare, Speaker Paul Ryan’s AHCA left it essentially intact beyond a cosmetic rebranding — replacing it with a “surcharge” that similarly penalizes those who are uninsured.
“The individual mandate is a conservative principle — a principle of ‘no free riders,’ that ‘everyone ought to be paying their fair share’ — that comes out of the ’70s and ’80s. That’s a conservative idea,” said Rep. Ami Bera (D-CA), going on to add that he also supports it.
Ryan has said he couldn’t go further with the health care bill because of the limits imposed by the budget reconciliation process, which really does constrict what he can include. But House Democrats also think it’s no coincidence that Ryan has left in place many of the key Obamacare provisions that stole from the GOP playbook.
“The Affordable Care Act really was a combination of Republican and Democratic ideas,” said Rep. Kurt Schrader (D-OR), who like Bera and Kind is a member of Democrats’s moderate “New Democrats” caucus. "But now Republicans are having a tough time extricating themselves from their rhetoric against it. They now have nowhere to go."
The best example of this may be over the individual insurance marketplaces. Conservatives don’t like to hear it, but the concept — a cornerstone of the Affordable Care Act — was loved and extolled by the Heritage Foundation for decades as an alternative to government-run health insurance.
“There's little doubt that Heritage has been a consistent and eager promoter of the exchange idea, especially during the effort to design a new health care system for Massachusetts,” PolitiFact wrote in 2013.
And despite his House majority, Ryan decided to essentially preserve the basic structure of the exchanges. (His bill did dramatically reduce tax credits for those on these exchanges.) “The ACA took the best aspects of the Massachusetts/Romney plan and tried to put it on a national scale,” Schrader said.
The bill suffered from getting branded as “Obamacare lite” — because it’s true
Many Republicans will try to lay blame for the bill’s failure at the feet of the House Freedom Caucus. Co-chair Mark Meadows (R-NC) demanded that the bill strike Obamacare’s “essential health benefits,” eliminate the single risk pools (another idea in Hatch’s 1993 bill), and get rid of the lifetime ban on annual limits.
Where the Freedom Caucus was right is that Ryan did keep in place much of the existing Obamacare framework.
“The Freedom Caucus is right: This plan is ‘Obamacare-lite’ in a lot of ways,” says Schrader.
Attempts to dismantle Obamacare were always doomed to fail because of the gulf between the conservative reality of the law and its myth in the Republican imagination. Truly getting rid of it, as the Freedom Caucus wanted, would have represented moving in a far more conservative direction than Republicans have typically wanted.
“Republicans’ original sin on Obamacare was falsely portraying the centrist substance of the ACA as strictly partisan. It wasn’t,” said Adam Jentleson, a former aide to Harry Reid, then the Democratic Senate majority leader.
Jentleson added: "Those who worked on and covered the bill know there were GOP senators who wanted to support ACA — but McConnell twisted their arms. Now Republicans' seven-year lie that Obamacare was a partisan bill in substance is caching up with them for one simple reason: Obamacare IS what bipartisan, centrist health reform that keeps the private market intact looks like. There aren't many other options.”