For eight years, Republicans waged a war against Barack Obama’s health-care law, holding dozens of repeal votes, filing lawsuits and branding it a dangerous government takeover.
“I think it’s pretty obvious, the Democratic House is not going to be interested in that,” said Senate Majority Leader Mitch McConnell (R-Ky.), who suggested instead that lawmakers address the flaws in the Affordable Care Act “on a bipartisan basis.”
Beyond the practical barriers, Republicans also offered a political imperative for abandoning the nearly decade-old fight: the defeats they suffered to Democrats who ran hard against their efforts to roll back the law.
The GOP faced a moment of reckoning on an issue that helped them ascend to power in 2010 and which some now believe has been part of their downfall. They must chart a path forward amid disagreements within the party about the best strategy.
“The Republicans set out to ‘repeal and replace’ Obamacare but ended up being defined by the Democrats to devastating effect this cycle,” said Dan Eberhart, a Republican donor and fundraiser.
Democrats took a victory lap Wednesday after seizing control of the House and gaining governorships. They credited their victories to running a disciplined campaign that invested heavily in drawing a contrast with GOP candidates on health care.
In television ads, stump speeches and debates, Democrats called out Republicans for trying to undo the ACA. They focused attention on the law’s protections for people with preexisting medical conditions and urged voters to envision the consequences of losing those safeguards.
“Health care was on the ballot, and health care won,” said House Democratic leader Nancy Pelosi (Calif.).
Voters most frequently chose health care as their most important issue, exit poll data shows. Meanwhile, three conservative states — Idaho, Nebraska and Utah — approved ballot measures to expand Medicaid under the ACA.
Democrats said the success they had campaigning on health care, including in areas that voted for President Trump in 2016, will inform future campaign strategies.
Sen. Robert P. Casey Jr. (D-Pa.), who won reelection by 12.8 percentage points in a state Trump carried in 2016, said he focused on health care “every single day.” The election should serve notice that Democrats benefit from defending the law, he said.
“When you don’t defend something over a decade, you get your head kicked in, which we did for a lot of years,” Casey said. He recalled political consultants advising Democrats in 2012 not to focus on the ACA.
A turning point in the debate over health care occurred when Republicans took complete control of the government in 2017. They had used the ACA during the Obama years as a rallying cry for voters to put them in power. Once they had it, they promised, they would use it to take the law apart.
They tried and failed, embarking on a contentious effort that collapsed in defeat at the hands of three Republican senators who opposed it. No Democrats supported the plan. The outcome strained relations between Trump and McConnell and marked one of the lowest points of the new Republican government.
“We had Obamacare repealed and replaced. Unfortunately, one person changed his mind at the last moment,” Trump said Wednesday, as he once again referenced the late senator John McCain (R-Ariz.).
The president sounded bipartisan notes on health care, saying, “We want to do something on health care; they want to do something on health care. There are a lot of great things that we can do together.” But it remains to be seen whether cooperation is possible.
Last month, McConnell said the failure to repeal the law was “the one disappointment of this Congress from a Republican point of view.” In an interview with Reuters, he said, “If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks.”
While Republicans did poorly in House elections, they performed well in the Senate, where most of the battlegrounds were in states Trump won. Republicans picked up three Democratic-held seats. Democrats flipped only one GOP seat. A pair of too-close-to-call races could add to the totals on each side.
McConnell said Wednesday there are “serious problems with Obamacare” that need fixing. But he emphasized that they must be approached in conjunction with Democrats.
At the same time, there is pressure in the conservative movement to keep up the fight to take down the law, no matter the difficulty or the political implications.
“I think it needs to be repealed,” conservative activist L. Brent Bozell III said. “There’s a solemn commitment that the Republican Party made with its base, and to end this effort is to betray them.”
In the House, Republicans will no longer control the agenda, giving them no hope of spearheading a repeal effort. “At this point, any changes are going to have to be incremental and cumulative in a divided government,” said Rep. Tom Cole (R-Okla.), an ally of House Republican leaders.
In addition to assailing Republicans for the 2017 repeal push, Democrats also went after some Senate candidates who signed on to a lawsuit targeting the ACA.
It didn’t work in Missouri, where Attorney General Josh Hawley (R) ousted Sen. Claire McCaskill (D). But allies of Hawley said there was some nervousness about the attacks near the end of the campaign. The lawsuit he joined has not yet been decided.
McConnell accused Democrats of raising the “phony issue of whether or not we were for or against preexisting conditions” protections and added, “I suspect it may have worked some places.”
“Fortunately, in our races,” McConnell said, “even though they tried to define health care on that issue, I think all of our candidates who subsequently won were able to make clear to the voters that they” supported protections. Hawley said he supported protections — but not through the ACA.
Both Republicans and Democrats said that over time, and as the ACA has taken root, it has become harder for the GOP to bash it as an unfamiliar or hypothetical initiative. Polling from the Kaiser Family Foundation shows that views of the law have become more favorable in recent years.
Facing a possible loss is Rep. Tom MacArthur (R-N.J.), author of a House bill’s provision that would have weakened the core protection for those with preexisting conditions. He trailed his Democratic rival, Andy Kim, who had widely criticized the incumbent over health care.
To some Republicans, the election served as a stark reminder of the new contours of health-care politics, rather than a call to retreat from a partisan showdown.
“Republicans who didn’t pay attention to the implications of gutting Obamacare walked into the buzz-saw of preexisting conditions, which was a very effective issue for Democrats this year,” said Steven Law, a former McConnell chief of staff who runs the Senate Leadership Fund, a conservative group.