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What Trump’s Health-Care Loss Means for Obama’s Legacy

It seems Americans are OK with the Affordable Care Act after all.

By Jared Keller


(Photo: Mandel Ngan/AFP/Getty Images)

After more than seven years of congressional meltdowns and a 2016 election cycle built on the promise of a repeal, Republicans are discovering a hard truth about Obamacare: It’s way easier to give taxpayers government benefits than to take them away.

On Friday, House Republican leaders withdrew their legislative attempt to repeal and replace President Barack Obama’s signature Affordable Care Act amid “a revolt among conservatives and moderates in their ranks,” the New York Timesreports. The surprise move came after a week of tense wrangling between congressional GOP leaders and President Donald Trump, who made the radical transformation of Obamacare the center of his presidential campaign.

For Trump, the collapse of the House GOP replacement looks like a “humiliating defeat,” per the Times:

Failure of the House effort leaves the Affordable Care Act in place, with all the features Republicans detest.

The Republican bill would have repealed tax penalties for people who go without health insurance, rolled back federal insurance standards, reduced subsidies for the purchase of private insurance and set new limits on spending for Medicaid, the federal-state program for more than 70 million low-income people. The bill would also have repealed taxes imposed by the Affordable Care Act on health insurance providers, manufacturers of prescription drugs and medical devices, and many high-income people.

The Times story underscores a fundamental truth about Obamacare: Americans generally like their new insurance, and boy do they want to keep it. According to a February poll from the Kaiser Family Foundation, 48 percent of Americans surveyed view Obamacare favorably, the highest favorability level of the scores of polls conducted by the group since the ACA was passed in 2010. While public approval of Obamacare had slumped to a near-historic low nearly a year ago, according to RealClearPolitics’ polling tracker, it has only improved in the public’s mind in the year since. And that’s not just in one or two polls, but dozens.

An Obamacare repeal would have hurt those voters who railed against the legislation at Trump rallies in 2016 — and those voters probably know it now. As a grim Congressional Budget Office report earlier in March made clear, the GOP-backed American Health Care Act would have left more than 14 million Americans without health insurance as of 2018 — a number that would have risen to 21 million more uninsured by 2020. Yes, it would have reduced the deficit by some $337 billion over the next 10 years, but voters tend to care more about their immediate benefits than abstracts like deficits. After all, a Reuters/Ipsos poll released just this morning found that almost half of respondents saw the AHCA as “not an improvement” over Obamacare.

But why? Didn’t all those voters who turned out for Trump vote for the unusual new president because they actually wanted a repeal? Not necessarily: There’s a theory, flagged by the Times in February, that the public’s perception of government power actually tends to move in opposition to the ideological preferences of the party swaggering through Washington, D.C.

“The public becomes more liberal during the administration of Republican presidents, and more conservative under the administration of Democratic presidents,” the Monkey Cage’s John Sides observed in 2013. “What’s particularly interesting is that the health care spending question, which has been included in the most Pew batteries, shows the most thermostatic effects: drops in support for increased health care spending in response to debates about both the Clinton and Obama health care plans.”

With Republicans in power, even those who stood against health insurance mandates are now considering the possibility that maybe the ACA isn’t as bad as they thought. And Republican leaders seem to realize that. “Obamacare,” Speaker of the House Paul Ryan conceded in a Friday press conference, “is now law of the land.”

Good thing—it’s a law Americans seem to actually want.