Republicans voted some 50 times to repeal Obamacare when President Obama was still president and there was no danger of their repeal actually becoming law. They lambasted President Obama's crowning achievement in office for every problem with American health care and ran for eight years on a promise to repeal it. But suddenly now that they have total political power: the House, the Senate and the presidency - they don't seem to be able to come up with a plan that has even a majority support in the US Senate, let alone clear its 60-vote legislative hurdle that will kick in October 1.
The Graham-Cassidy bill that has gained - and lost - steam of late is yet another attempt by the Republicans to take healthcare away from tens of millions of people who now have it and repeal patient protection regulations impacting nearly every American. The bill is hardly different from other failed Republican attempts to turn back the clock on progress, complete with rolling back Medicaid expansion, deep funding cuts, and gutting standards that make insurance affordable for people with pre-existing conditions.
Once again, this is what the Republicans campaigned on for the better part of a decade. And yet - despite Cassidy and Graham's revised bribes to holdout Senators from Maine, Alaska, Arizona and Kentucky - the GOP's latest effort at repeal appears no closer to passage.
To hear the pundits discuss it, Republicans are having a tough time having the ends meet on their batshit crazy... I mean "conservative" and slightly less insane ("moderate") wings of the party. Some GOP senators from Medicaid expansion states are weary of their states losing money (and they would - all 50 directors of Medicaid have come out against Graham-Cassidy), while others are concerned that the insurance market will not be turned into the wild west.
And the pundits are right - the surface battle is happening between Republican senators who want to keep their states' honey pots and those who want everything stripped out and defunded. If you move "too much" one way, it is thought, you bleed enough support on the other side to any bill non-viable.
What is not being discussed, however, is why this divide is suddenly an issue within the Republican caucus. These are largely the same people who en masse voted against the Affordable Care Act in the first place. More than that, the thin public support for various iterations of the Republican proposal coupled with rising approval of Obamacare belie the public outcry that almost derailed Obamacare's passage and punished its supporters dearly in elections since.
One explanation for this is certainly the fact that Republicans have been exposed as fraudsters and liars who could not put together a viable alternative to Obamacare despite having the better part of a decade to work on it.
But the broader fact underlying all of this is a tectonic paradigm shift in Americans' view of health care. When President Obama was using up his considerable political capital to expand access to health care, Americans still viewed health insurance as an individual benefit one earned through having a good job or enough money, while the government only stepped in for people who otherwise couldn't care for themselves: poor children, the elderly, and the disabled.
Insurance itself was loosely regulated and left as a matter of contract law. It was viewed as a private contract between two private parties. If an individual forgot to mention they had acne when they were 14, too bad. If an individual could not afford the insurance their employer was providing, they needed to get a better job.
The Affordable Care Act altered this basic proposition. By expanding Medicaid to the working poor and by setting up a system of subsidies to the middle class to help them buy insurance, Obamacare turned health insurance for everyone into a social responsibility. The ACA encapsulated the role of the government to fulfill that responsibility as well as to regulate the insurance companies to ensure that people could not be denied coverage because of a pre-existing condition, or charged a higher premium because they were born with lady parts. Obamacare included individual responsibility both to make the markets work and to ensure everyone, including the healthy and wealthy, play their part.
Obamacare altered the very paradigm on health insurance from a matter of individual worth and burden to one of social, shared responsibility. It altered the paradigm of insurance plans from mere business transactions to the regulated confines of a strong patients' bill of rights.
In the past seven years, that paradigm has taken hold, and Americans like it better than the old one. Americans now want the government to help pay for insurance for anyone who couldn't otherwise afford it, not just for the single parent who makes less than 50% of the poverty level or the infirm. Americans now want the patient protections they have under Obamacare. Americans are now showing up to town hall meetings by the droves and demanding to know from their Republican senators and representatives why they want to take away this safety net.
Republican attempts - despite their unchallenged power in Washington - is faltering because they are failing to abide this new paradigm and trying to return us to the wild west paradigm of health insurance.
This, I will remind the Left's detractors of Obamacare because of its perceived impurity against liberal standards, is why we said here at TPV again and again that it was essential to support and enact Obamacare. It was never just about the individual subsidies or rate parity or the numerous other positive policy changes in the Affordable Care Act. Of course, each of those alone would have made a policy change worthy.
Far, far beyond the individual policy implications, Obamacare is essential because of the paradigm shift it created. Obamacare literally changed the way Americans think about healthcare.
Thanks, Obama!