In 2010, the Affordable Care Act was signed into law by President Barack Obama. It was a signature piece of legislation, a personal commitment for which he had lobbied hard for support from the House of Representatives. The new Act promoted more efficient ways to provide care with better outcomes; covered 24 million Americans who had previously had no health coverage; and required insurers to accept all applicants, regardless of their pre-existing conditions or gender.

<> on March 23, 2010 in Washington, DC.

President Barack Obama signs Affordable Care Act March 23, 2010 (Alex Wong/Getty Images)

Since its introduction, increases in overall healthcare spending have slowed and the Congressional Budget Office – a federal agency that provides budget and economic information to Congress – reported it would reduce the federal deficit.

But from the time it was passed into law, the Act has been opposed by the Republican party. There have been more than 60 unsuccessful Congressional votes to defeat it, the Supreme Court has been forced to debate it four times, and in 2013 it was at the centre of a two-week government shutdown.

While there are many reasons for the opposition (including the obvious political game of oppose anything your opponent supports), Republicans have expressed concern in a number of areas:

  • they view universal insurance as government meddling in the private doctor-patient relationship
  • they oppose insurers, who have lost money as customers have been older and sicker than expected, passing those costs on to wealthier Americans (presumably more of whom support the Republican party)
  • they oppose state-offered health care, calling it “socialized medicine,” advocating instead for the private insurance system.

In the years following passage of the Bill, the Republicans coined the phrase “Obamacare,” hoping to tie all the problems associated with it personally to the President.

During the 2016 Presidential election, “repeal and replace” became the mantra of the Republican party in relation to Obamacare. Donald Trump promised that if elected President, he would immediately call Congress into special session to repeal Obamacare as one of his first actions as President. “We will do it and we will do it quickly.”

In early January, 2017, he repeated the promise.

So, what happened?

On March 24, just hours before the vote was scheduled to take place (already delayed several times to give the Republicans more time to nail down support from their party members), House Speaker Paul Ryan had to admit to the President that the party did not have enough votes to repeal Obamacare. The vote was cancelled. The Affordable Care Act remains in place.

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House Speaker Paul Ryan speaks to media after pulling bill to replace Obamacare (AP Photo/J. Scott Applewhite, March 24, 2017)

In typical Trump style, he blamed the Democrats for the defeat, saying they would be responsible for the eventual collapse of Obamacare. What Trump didn’t say was that the Republicans have control of the White House, the Senate and the House of Representatives. Complaining that “we had no support from Democrats” is hardly an excuse, since Obamacare was a Democratic initiative that Democrats have always supported. They never intended to support its defeat. Why would they?

Trump Celebrates Greek Independence While Republicans Brace for Health Care Vote

President Donald Trump following failure of bill to repeal Obamacare (Jim Lo Scalzo/EPA/Newscom, March 24, 2017)

Now Republican legislators will have to explain to their supporters and constituents why they couldn’t manage to “repeal and replace” as they have been promising for years, despite having control over the Executive and Legislative branches of government.

While there are many examples of political parties at loggerheads over policy issues, this debate, and the subsequent failure to gut the legislation, has been very alarming for a number of reasons:

  • Trump has said that it would be better for the Republicans to let Obamacare implode, blame the Democrats and then introduce a new bill. Not only is this an incredibly inappropriate and unprofessional way for a President to act, it would also lead to dangerous consequences for millions of Americans. We aren’t talking about a minor policy debate here. We’re talking about health care. Any implosions would put people’s health and lives at risk, for purely political reasons.
  • Trump doesn’t appear to understand how the political process works to get the bill repealed or what he would replace it with. Consider his response to a question at a news conference in January about how he would deal with the issue: “We’re going to be submitting, as soon as our secretary is approved, almost simultaneously — shortly thereafter — a plan. It will be repeal and replace. It will be, essentially simultaneously. It will be various segments, you understand but will most likely be on the same day or the same week — but probably the same day — could be the same hour. So we’re going to do repeal and replace — very complicated stuff. And we’re going to get a health bill passed — we’re going to get health care taken care of for this country.” What does this even mean?
  • Perhaps most surprising – or most shocking – are the Americans who have said they oppose Obamacare, without realizing they are covered by Obamacare. As this one example from Facebook shows, many Americans have been so caught up in the rhetoric of Democratic vs Republican plans that they don’t even understand what plan covers their own care.

What happens now is anyone’s guess. But one thing we know for sure is that President Trump will not repeal and replace Obamacare early on his mandate. It will not be one of his first successes. And he has no one to blame but himself.

“It was hard to square his bravado with the stunning reality of what had just happened. A President with a reputation as a dealmaker, author of The Art of the Deal, going down to defeat on his first significant piece of legislation, a momentous one at that, because of a rebellion from a faction of his own party, on one of the party’s signature issues.” (Toronto Star, March 24, 2017)

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