When the full and definitive story of the Affordable Care Act is finally written, future historians will struggle mightily to explain the Republican position — unless, that is, they are schooled in the ways and wiles of hypocrisy, gamesmanship, artifice, and revenge.
Which makes it all the more fitting that the last chapter or so may tell the tale of how the GOP’s relentless and rabid assault on the law ultimately came back to bite the party in the butt.
Let’s start our own overview back at a point when conservatives were looking for their own approach on health care. The Heritage Foundation developed an interesting set of ideas: a legal mandate requiring individuals to carry health insurance, and the creation of exchanges where they could easily compare and purchase policies.
Enter Mitt Romney, then the Republican governor of Massachusetts. When a study by the Urban Institute spoke favorably of the individual mandate as a way to expand health coverage, Romney seized on the concept. It was, after all, an idea that both rested on and reinforced the pre-Trump-era conservative tenet of personal responsibility.
Thus was born Romneycare, the bipartisan Bay State effort to expand coverage.
When Barack Obama became president, he saw an opening for a similar bipartisan accomplishment by pursuing a similar plan. After all, a logician might well have thought Republicans would applaud a Democrat for embracing an approach praised by some prominent conservatives and certified by a well-regarded right-wing think tank. The opposition party, however, had more important priorities than extending health coverage: thwarting the new president at every possible turn.
After Democrats passed the Affordable Care Act, conservatives began a series of legal challenges. Two made their way to the US Supreme Court, which twice ruled in the Obama administration’s favor. Those decisions, alas, did not reconcile Republicans to the ACA. No indeed. Rather, it led them to see a chief justice with sterling conservative credentials as an ideological renegade.
Time passed. Republican opposition to Obamacare did not. Otherwise lackadaisical congressional conservatives pursued ACA repeal with the energy of a dozen beaver colonies in dam-building season. Repeal vote followed repeal vote in a dizzying array, even though everyone knew those efforts were a waste of time while Obama remained president.
Then, dismayingly or miraculously (depending on the degree of rationality that informs one’s perspective), Donald Trump came to office. Apparently still seething about the comedic skewering Obama had delivered at a White House Correspondents’ Dinner in response to his birther nuttiness, Trump wanted to eradicate everything his predecessor had done. Although he had promised to replace the ACA with much better and cheaper health care that took care of everyone, Trump and congressional Republicans offered up a scheme that would have resulted in 22 million fewer people being covered. Public consternation ensued, which helps explain why, now that they actually had the power to do so, Congress failed to repeal the ACA.
Still, GOP opponents advanced their goal the way one might pursue a tedious argument of insidious intent. They slipped language into their 2017 tax cut law nixing the fiscal penalty that enforced the individual mandate. Republican state attorneys general then used the congressional elimination of that provision to launch yet another legal challenge, arguing that the entire law was now unconstitutional.
Despite Trump’s repeated posturing about protecting coverage for people with preexisting conditions, his administration is supporting the legal challenge to the law that makes those protections possible.
Which is where our story takes its current interesting twist. Although the administration wanted to delay that lawsuit until next year, the Supreme Court will probably hear it this fall, as Americans are preparing to go to the polls — and at a time when 55 percent of them now support the ACA.
Which means that our long and tangled tale could conclude with a delicious just-desserts electoral twist. The GOP’s Ahab-like obsession with killing Obamcare may end up helping sink its own ship.