The Senate Republican health-care bill would go beyond repealing parts of Obamacare to drastically restructure Medicaid. (Photo by Chip Somodevilla/Getty Images)

Throughout the modern history of Congress, lawmakers have inexorably expanded progressive social policies, and while conservatives have successfully forestalled expansions to the social safety net, they've had very little success in reversing them.

Right now, however, Republicans have a chance to buck that trend, as they prepare legislation aimed at repealing and replacing the Affordable Care Act, also known as Obamacare. The Senate bill released on Thursday, coupled with the House bill passed earlier this year, would be exactly the kind of cuts to the welfare state that conservatives have consistently failed to achieve.

The repeal measure, which follows weeks of unusual secrecy in its drafting, would bring down taxes, eliminate hundreds of billions of dollars in outlays on the social safety net and curtail the federal government's involvement in a crucial sector of the economy.

Senate Majority Leader Mitch McConnell (R-Ky.) unveiled the legislation that would reshape a big piece of the U.S. health-care system on Thursday, June 22. Here's what we know about the bill. (Monica Akhtar/The Washington Post)

The American right has had few chances to enact such far-reaching legislation. For decades, Democrats controlled the House, and Republican presidents have often pursued moderate or progressive domestic agendas. Public programs established by Democrats have proven popular among beneficiaries, and it has been difficult for Republicans to dismantle them.

Conservative principles have often won out in foreign policy, in the courts and at the level of the states, but the trend in federal lawmaking has long been to the left. The Republican health-care bill would be an exception. The law would go beyond repealing parts of Obamacare to drastically restructure Medicaid, a 52-year-old program.

“The more common pattern in the U.S. is that progressive social policies have been prevented, rather than rolled back,” said Julia Lynch, a political scientist at the University of Pennsylvania.

“Until now, the growth of the welfare state has occasionally been slowed, but never reversed in any major way,” noted H.W. Brands, a historian at the University of Texas at Austin, in an email.

Here's a timeline of some of the rare big wins for congressional conservatives.

1947: The Taft-Hartley Act

After the Second World War, Congress dealt a blow to organized labor, removing one of the main reasons for workers to join unions in many states. Employers gained the ability to hire workers who were not members of their union but who were still paid according to the union contract, as long as their state passed what is known as a “right-to-work” law.

Proponents have argued that right-to-work legislation has helped workers get jobs even if they do not want to be members of a union. At the same time, these laws have allowed workers to enjoy the benefits of collective bargaining without paying union dues, diluting the political clout of organized labor.


Activists and organizers often cite the Taft-Hartley Act, as the bill Congress passed in 1947 is known, as one of the reasons union membership has declined since the Second World War. There have been economic burdens on unions as well, however. Competition from industrial robots and overseas labor has put limits on their bargaining power.

The Republican health-care bill has followed a parallel trajectory to the Taft-Hartley law. Much as the GOP bill is a response to Democrats' victory on the issue a few years ago with Obamacare, the Taft-Hartley bill weakened New Deal labor legislation enacted in 1935. The law did so by devolving some authority over collective bargaining to the states, just as Republicans hope to give states the freedom to waive certain requirements in Obamacare.

There is one notable difference, though. Congress passed the Taft-Hartley Act with broad bipartisan support, as conservative Democrats joined Republicans to override a veto from President Harry S. Truman, a Democrat. Republicans appear unlikely to win any Democratic votes for their health-care bill.

1981: Reagan cuts taxes

Congress passed the Taft-Hartley Act amid a long series of defeats for American conservatism.

Beginning in 1933, Democrats had taken control of the House, and they remained in power for decades, with only a few exceptions. Meanwhile, Republican presidents pursued centrist agendas.

President Dwight D. Eisenhower profoundly expanded the federal government's involvement in the economy with the Interstate Highway System. Richard Nixon supported a health-care overhaul that would have been substantially more progressive than Obamacare.

That changed with President Ronald Reagan, who won election in 1980 in part on a promise to bring down taxes. In his first year in office, he signed a major tax cut into law.

He brought down the marginal rate paid by the wealthiest taxpayers on their income from 70 percent to 50 percent. The law weakened the estate tax and offered businesses more favorable treatment on their investments.

Reagan's 1981 bill passed Congress with bipartisan support. The House, controlled by Democrats, voted 323 to 107 in favor of the law.

Had that law stood, it would have been the most significant reduction in taxes in modern times, reducing federal revenue by 2.9 percent of gross domestic product. Yet the law forced the federal government to borrow more to make up for the forgone revenue. During the rest of his administration, Reagan was repeatedly forced to increase taxes to deal with mounting deficits. Ultimately, he replaced about half of the original cut with tax hikes.

1996: Welfare overhaul

Arguably, the best precedent for what Republicans hope to achieve in undoing Obamacare is the welfare overhaul that President Bill Clinton signed in 1996, which eliminated a major federal entitlement and — over time — reduced the financial support available to poor American families.

The overhaul, a joint effort by the Clinton administration and Republicans in Congress, generally required Americans to work, volunteer, participate in vocational training or meet other requirements to receive cash assistance from the government. Like the Taft-Hartley Act, Clinton's bill left much of the actual policymaking to states, which gained new authority to impose restrictions on welfare.


And like the Republican health-care bill released Thursday, Clinton's overhaul reduced federal spending over many years through inflation. The Republican bill would limit spending on Medicaid to an index of inflation, but spending on Medicaid is increasing more rapidly than inflation as beneficiaries get older and require more expensive treatment. The result would be a cut to the program likely approaching $1 trillion, although official estimates are not yet available.

Clinton ran on a promise to overhaul the welfare system, but the retooling was in part the result of agitation from conservative lawmakers such as Rep. Newt Gingrich (R-Ga.), then the speaker of the House. Republicans had won the House two years earlier, ending generations of Democratic control, and Clinton was in the middle of a difficult campaign for his reelection at a time when public opinion had turned against the welfare system.

He vetoed two bills sent to him by Republicans, who were now in control of Congress, before signing the bill over the objections of liberal Democrats on Capitol Hill and in his own administration. Two of his top advisers on poverty policy resigned in the wake of the bill.

2001-2003: Bush cuts taxes

President George W. Bush sought to mimic Reagan's achievement by cutting taxes as well, with a series of three tax-relief bills totaling about 1.3 percent of GDP between 2001 and 2003.

The rest of Bush's administration might have been a disappointment to conservatives, however. He increased federal borrowing by expanding benefits under Medicare, and his plan for free-market overhauls to Social Security did not win support in Congress.

A handful of Democratic lawmakers voted in favor of the tax cuts, but the parties had long been drifting apart ideologically, and there were fewer of the kind of conservative Democrat that had supported limited-government legislation in the past.

Republicans have shifted to the right as well, and they are now are pursuing a health-care policy that will likely draw opposition from nearly all Democrats, but some moderate GOP lawmakers, too.

That fact demonstrates the enduing difficulty for conservative activists of unwinding social programs that help large numbers of people get by.

“If it is enacted, it will certainly be historic,” said Norm Ornstein, a political scientist at the right-leaning American Enterprise Institute. Conservatives, he said, find themselves in the unfamiliar position of “being able to pass and get through a dramatic change in an important area of policy that really does take a meat-ax to government in terms of size and role.”