As the seven-year Republican effort to repeal the Affordable Care Act crashed on the threshold of the Senate, President Trump offered his party a rescue strategy. Step one: Blame Democrats. Step two: Win more seats and try again.
“We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it,” said Trump. “In ’18, we’re going to have to get some more people elected. We have to go out and get more people elected that are Republicans.”
Trump made explicit what Republicans had been hoping since the repeal fight started — that whatever happened, voters would blame the Democrats for their health-care costs. It’s an audacious strategy that flies against current polling and electoral history. It counts on messaging, distracted voters and a built-in electoral advantage to guide the party past the rocks.
“The worm’s kind of turned on this issue,” said Tom Davis, a former Republican congressman from Virginia who ran the party’s House campaign group in several cycles. “Republicans might have gotten a break by not seeing an unpopular law go into effect. Sometimes, having no law is better than having one that people perceive as bad law.”
By the time the Better Care Reconciliation Act tanked late Monday, Trump had repeatedly predicted that the “disaster” of the ACA would collapse, forcing Democrats to the bargaining table. The administration’s indecision on whether to keep funding subsidies for plans bought on ACA exchanges had been cited by many insurers announcing rate hikes or canceled plans — announcements that the administration cited as proof of collapse.
Polling, however, found most voters ready to blame Republicans for the rate hikes. An April survey by the Kaiser Family Foundation found 60 percent of voters opposed to using the subsidies as bargaining chips; even 28 percent of Republicans were opposed. Seventy-four percent of voters said they wanted the administration to “make the law work,” and 64 percent said that “President Trump and Republicans in Congress” would be accountable for “any problems.”
Even some Republicans who wanted to force Democrats to negotiate said that six months of negotiations had sapped the party’s momentum. “I advocated collapse and replace for months,” said Sen. Lindsey Graham (R-S.C.). “But we’re so deep into this thing right now, I don’t even know if that’s a viable option.”
In interviews Tuesday, Democrats who face re-election in 2018 expressed disbelief at the idea that they, not Trump, would be held accountable for problems with the health-care system.
“I have a bill in that will stabilize the individual market, if they’d just allow the Senate to work,” said Sen. Tim Kaine (D-Va.), the party’s 2016 vice presidential nominee. “Let the committee chairs tackle this.” If premiums spiked, said Kaine, voters would look to “the party that’s governing, that refuses to allow a process that would bring premiums down.”
Sen. Bill Nelson (D-Fla.), who may be challenged by longtime ACA opponent Gov. Rick Scott (R-Fla.), said that he was eager to work with Republicans on shoring up the subsidies. Voters back home, he said, clearly saw the Trump administration as the impediment to fixing the law.
“Let me tell you, people are coming out of the woodwork,” said Nelson. “I go to the Tampa Bay Rays game, I throw out the first pitch, and people are begging: Don’t let them take away my health care. People are onto this.”
Nelson is one of 10 Democrats up for reelection in states won by Trump last year, a factor that Republicans once thought would scare incumbents into making deals. Instead, Democrats have grown more confident about their 2018 chances, with few top-tier candidates jumping into “Trump state” races, and credible Democrats running for seats in Nevada and Texas.
In all of those races, it’s not clear how “Obamacare” will play, or how Republicans will play it. From April through June, the GOP played a perfect game in four special House elections, winning by single digits in typically Republican districts. Yet for the first time since 2010, Obamacare repeal was not a focus of Republican ads and attacks.
Instead, Republicans moved closer to attacking Democrats on what they might want to build on top of the ACA. In Montana’s special election, that was the Medicare-for-all plan favored by Sen. Bernie Sanders (I-Vt.). In a series of statements this month, the Republican National Committee and National Republican Congressional Committee went after Democrats on the estimated cost of creating a single-payer system, similar to Canada’s, in the United States. In districts where vulnerable Republicans had cast votes for repeal, putting them on the record for Medicaid cuts and high estimates of lost health insurance, Republicans would warn that Democrats wanted socialism.
“Their House primaries are starting to look like a ten-car pile-up and the activist base is screaming for Democrats to run on single-payer health care,” wrote NRCC spokesman Jesse Hunt in a press release just hours before the Senate repeal push collapsed.
“They don’t want to get us off of the Obamacare train; they want to double-down on a failed system that is in the middle of a collapse,” House Speaker Paul D. Ryan (R-Wis.) said at a Tuesday morning press conference. “Ultimately, it’s very clear that they’re more interested a single-payer system which means government-run health care. Government-run health care is not in our nation’s interest.”
Other Republicans suggested that the health care issue could fade as the election approaches — an advantage for the party, so long as it doesn’t fumble on anything else it has promised.
“It’s more important for Republicans to do something on taxes,” said Davis. “If they can’t produce on that, then I think they have a problem.”