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Here’s the real reason Republicans can’t repeal Obamacare

  • The Republican plan to replace, or at least repeal, Obamacare has reached its latest, and potentially final, roadblock.
  • The GOP was destined to fail no matter what plan they came up with.
  • Obamacare was a Republican idea in the first place. There is no other option.
President Donald Trump speaks as Senate Majority Leader Mitch McConnell (R-Ky.) smiles in the Roosevelt Room at the White House.
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President Donald Trump speaks as Senate Majority Leader Mitch McConnell (R-Ky.) smiles in the Roosevelt Room at the White House.

The Republican plan to replace, or at least repeal, Obamacare has reached its latest, and potentially final, roadblock. The Senate failed to secure enough votes for its replacement plan and seems out of options for repealing the Affordable Care Act for the foreseeable future.

But no matter what plan the GOP came up with – repeal and replace, repeal and delay – they were destined to fail. That's because the ACA was already a compromise, politically viable in part because it was based on blueprints from one of the Republicans' most visible governors: Mitt Romney.

It was a gambit Republicans can't undo, and now the party has to decide whether they want to move forward and use the considerable tools available to improve the ACA, or continue railing at the ghost of Romneycare.

Obamacare vs Romneycare

A single-payer health insurance system is a Democratic dream. Democratic administrations from Truman to Clinton tried and failed to pass such a program. Faced with reality, though, the Obama administration put forth an exchange-based plan that kept private insurers as its foundation.

Many on the left and the right were unhappy about the proposal, but eventually it achieved its goal of reducing the number of uninsured Americans.

The blueprint for the ACA? The Massachusetts healthcare reform law passed in 2006 under then-governor Mitt Romney.

It was a practical choice to make. A single-payer overhaul of the national health insurance system was unlikely to succeed. Romneycare had already proven this type of free market but government-sponsored healthcare system could get bipartisan support.

That may not have played out in the votes for Obamacare (which fell along party lines) but it's important to the present, because it's one of the primary reasons Republicans haven't been able to pass a bill to replace it.

Obamacare, née Romneycare, was the most government involvement the Republican party could stomach and the least Democrats would settle for. There simply aren't more viable compromises out there. Efforts to draft a bill that costs less money, without negatively affecting coverage, have proven that. The only choice Republicans have ever had was to improve the ACA.

Republicans have to beat their own boogeyman

If Obama's compromise essentially backed Republicans into a corner they couldn't fight their way out of, why are they wasting time and political capital trying to overthrow the ACA? The simple answer is because they have to. They've spent the better part of a decade convincing their voter base that Obamacare is a terrible program.

The Republican fight hasn't been with the ACA as much as it has been with Obamacare – specifically, the "Obama" in "Obamacare." Obama himself tried to shed light on this by playing up the Romneycare name in the 2012 presidential election, and Romney said in 2015 that Romneycare directly facilitated Obamacare. But a health care plan by any other name is just as good for the people who benefit from it.

Recent polls and interviews show that a number of people think there's a difference between Obamacare and the ACA, and this has real consequences in places that rely heavily on the reforms the program brought, like expanded Medicaid. Many Trump voters in places like Kentucky, which benefited greatly from the ACA, didn't realize they were voting to get rid of their own health insurance. When removing that protection became a reality, the public shied away.

Then there's the trumping up of Obamacare's faults. "Dying," "failing," and "imploding" are commonly used to describe the current state of health insurance exchanges. But it turns out that death spirals may be as overblown as death panels.

The insurance exchanges are beginning to stabilize, the number of counties with no insurer coverage is relatively small (currently just over 1 percent, per the Kaiser Family Foundation), and most issues regarding premium increases are due to insurer uncertainty over how the Trump administration will act.

Republicans set up a boogeyman in the derogatorily nicknamed Obamacare. They had no choice but to at least try to replace it. But it's meant a largely unproductive half year that could have been better spent stabilizing health-care markets with the tools available under the current law.

The ACA isn't without problems. The issue of rising premiums needs to be addressed, and stability would be welcome so empty shelf counties don't need to be revisited each year. Funds already earmarked for subsidies like cost-sharing reductions and Medicaid expansion can help, if the Trump administration will put them to use. But it's hard to fix a leaky faucet when you've spent years claiming that the whole house needs to be torn down.

Over three years after the ACA went into effect, Republicans are starting at square one to put their stamp on the health insurance conversation. If there were a better idea out there than Romneycare, they probably would have thought of it by now. Trump and the Senate face an opportunity to embrace the ACA and start addressing its issues. Not all Republicans will be on board, but moderates can work with Democrats to enact real fixes that maintain coverage and contain costs.

President Trump has said that if and when Obamacare fails, his party is "not owning it" and voters will blame Democrats. But polling shows this isn't true, and that Republicans won't be able to pass the buck.

Instead, the GOP may be able to take some of the credit for fixing the problems plaguing the current health-care system. It won't be the win they campaigned on, but it's the win most Americans want. And at this point, Republicans should be pushing for any health care win they can get.

Commentary by Jennifer Fitzgerald, the CEO and co-founder of PolicyGenius, an independent digital insurance company for consumers. Previously, she was a junior partner at McKinsey & Company where she advised Fortune 100 financial services companies on marketing and strategy. She is a graduate of Columbia Law School and Florida State University. Follow her on Twitter @jenlfitzgerald.

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