The Obamacare repeal debacle is what happens when a political party overpromises

Republicans are engaging in one last attempt to repeal the Affordable Care Act (ACA, or “Obamacare”). The bill, put forward by GOP Senators Lindsey Graham and Bill Cassidy, is the newest iteration of this effort and is already scheduled for a vote next Wednesday. The urgency this time around is largely due to a ruling by the Senate parliamentarian, who said that Republicans have until the end of September to try to pass a bill through the reconciliation process — a procedure requiring only 51 votes for passage and disallowing the use of a filibuster.

Despite the numerous previous tries by congressional Republicans to repeal President Obama’s signature accomplishment, they have all failed. After the last one, the party decided it was time to move on to the rest of their legislative agenda, which could explain why this most recent push caught Democrats by surprise. They, like much of the public, had assumed the GOP’s failed attempt in July would put an end to the issue.

So why is this repeal effort back for one last Hail Mary?

It can’t be because the policy is popular. A new Public Policy Polling survey shows just 24% of the public supports Graham-Cassidy. Not even a majority of Republican voters approve of the bill.

It can’t be because the health care industry supports it. The groups opposing this bill include the AARP, American Cancer Society, American Diabetes Association, American Medical Association, American Hospital Association, Blue Cross Blue Shield Association, Children’s Hospital Association, Federation of American Hospitals, March of Dimes, and the National Health Council (to name a few).

It can’t be because the ACA has destabilized the healthcare industry. Every county in the country now has an insurer in the Obamacare exchanges. And, while premiums are slated to go up on the exchanges next year, it is not due to the ACA (which has actually slowed the annual growth of premiums in recent years). In fact, insurers have told us who will be to blame: the president. By refusing to commit to the steps necessary to keep the ACA’s markets operating smoothly, the administration is sowing unpredictability into them, which has spooked insurers. He has also gutted funding for advertising encouraging people to sign up for plans and get covered.

It can’t be because the party thinks this bill will do a better job of covering patients. Rather, it will repeal the Medicaid expansion that helped millions of Americans become insured. It also permits states to allow insurers to bring back the moral repulsion of denying care based on pre-existsing conditions and annual or lifetime insurance caps. It remains to be seen just how many people would lose coverage under this plan, and we may not even know until a vote is taken — Republicans could very well eschew a score from the Congressional Budget Office, which would likely offer them bad news.

And while the Senate parliamentarian’s ruling likely upped the level of urgency, it can’t be the sole reason why this push is back. As was previously mentioned, the party was ready to move on to tax reform following it’s last repeal defeat.

So, why do they insist on reviving Obamacare repeal efforts one more time? It’s easy: because they promised. For eight years, they have promised to do it. They won elections promising to do it, and now they are finally in place to finish the job.

The small problem is, for all of the criticisms they leveled at the law during those years, there was no actual replacement plan ready to go when they eventually controlled all levers of power in Washington — no plan that could have tried to account for nuances like pre-existing conditions, coverage gaps, and even intraparty differences. Sensing their window of opportunity to pass a repeal bill was closing with each passing day — especially as the president’s approval numbers dropped at a rapid pace — the party became desperate for a bill, ANY bill, that they could pass to show their voters they could be trusted to carry out their promises.

But, after a stalled House bill in May and three failed Senate votes in July, the party was right back where it started. A reasonable person might have asked, wouldn’t it be easier for Republicans to just say, “Look, we tried, and we failed. We’re on to tax reform”? For one thing, the party’s donors aren’t having it. But at the core of this issue is power. If Republicans can’t show their voters that they have the ability to follow through on their biggest promise of the past decade, why should those voters trust them with the power they were given? Why would voters support the party in the future?

And therein lies the harsh but predictable reality for Republicans: they know it’s nearly impossible to take away a benefit once people have it (which also explains why they tried relentlessly to derail the ACA before it could be fully implemented). Nevertheless, they have persisted. They have now put forward a bill that they are desperate to pass, regardless of the policy details or implications. The New York Times reports:

Senator Charles E. Grassley of Iowa, who has been deeply involved in health policy for years, told reporters back home that he could count 10 reasons the new health proposal should not reach the floor, but that Republicans needed to press ahead regardless in order to fulfill their longstanding promise to replace and repeal President Barack Obama’s Affordable Care Act. “Republicans campaigned on this so often that we have a responsibility to carry out what you said in the campaign…That’s pretty much as much of a reason as the substance of the bill.”

The story also notes that the party has seen a steep drop-off in donations, from both big donors and small. Republican desperation is no more evident than in the party’s attempts to buy off one senator who voted ‘no’ last time, something that is almost assuredly unconstitutional.

And now we’re on the verge of passing what could be one of the most extreme laws to come out of Congress in years — one that looks to take a hack saw to one-sixth of the economy, has no public support, and will likely have devastating consequences for vulnerable communities and individuals. Why? Because Republicans made a promise they knew would likely be impossible to keep. Now the rest of us have to hope that impossibility remains reality one last time.

Updated September 23: This post has been updated to include comments from Senator Chuck Grassley.