Why Republicans Are Losing the Obamacare Battle

"Frankly, GOP disunity on health care is what led to Obamacare in the first place."

The hits keep coming for the campaign to repeal Obamacare. A USA Today/Suffolk poll released this week showed that while Republicans are still pro-repeal by a 2-1 margin, Americans preferred fixing the law to repealing it by a 52 percent to 36 percent margin.

Dig deeper and you find that only 34 percent of independents said they were still on board with repeal, while 52 percent said Affordable Care Act opponents should try to fix the controversial health care law.

This comes on the heels of polling showing the public split on whether to view Obamacare favorably or unfavorably. In the not too distant past, pluralities and even majorities viewed the president’s signature legislative accomplishment unfavorably. This fact helped Republicans win two midterm congressional elections.

You can quibble with these poll results, and Democrats certainly ignored them when they were going the other way. In practice, states have still mostly resisted the Obamacare exchanges’ siren song, which is what made King v. Burwell such a huge potential threat to the law in the first place.

But after two failed challenges at the Supreme Court, President Obama’s re-election, the Obamacare defunding government shutdown and dozens of ill-fated congressional votes for repeal, the Affordable Care Act is starting to acquire an aura of permanence and inevitability.

Even the law’s most implacable foes warned that this could happen. Before launching his bid to stop Obamacare funding, Ted Cruz—the Texas senator and now 2016 Republican presidential candidate—said that once an entitlement becomes entrenched, there’s not much precedent for repealing it. That was a large part of the logic behind taking on Obamacare funding even with slim prospects for success.

But Republicans face a much bigger problem on healthcare than just inertia, one that would have become readily apparent if King v. Burwell had gone the other way. The party has yet to unite around a plausible alternative to Obamacare.

This is important, because Republicans quickly embraced the mantra of “repeal and replace” after the Affordable Care Act became law. The idea was that the unpopular law could be rolled back, but people would still want their concerns about health care addressed.

Years later, the GOP’s support for repeal is still well known but Republicans haven’t settled on a replacement. That lack of replacement is starting to undermine popular support for repeal. In some cases, Republicans want to retain the more popular Obamacare features while repealing the unpopular mandates and taxes that make the law financially workable.

Second, whatever Obamacare’s flaws it undeniably is providing people with health insurance. The more people who get coverage either through the exchanges or the Medicaid expansion, the bigger the constituency is for Obamacare. This is true even though Obamacare produces losers as well as winners. Some irreducible number of people will also credit Obamacare for their health coverage even if the law had nothing to do with it. (Some people certainly seem to have signed up for Medicaid post-Obamacare who didn’t need the expansion, for example.)

Frankly, GOP disunity on health care is what led to Obamacare in the first place. After the failure of Hillary Clinton’s health plan in 1994, Republicans declined to unite around a free-market approach to reforming the system. Instead they mostly breathed a sigh of relief and moved on.

Republicans mostly voted down Democratic health care policies or approved watered-down versions of the same.  That’s why we got Kennedy-Kassebaum, SCHIP and Medicare Part D, as just a few examples. Then there were ideas floating around to compete with Hillarycare that never got much conservative support, with the exception of medical savings accounts.

One of those ideas, emanating from the Heritage Foundation’s domestic policy shop, was the individual mandate. While it was never a consensus conservative policy, it found its way into the Massachusetts health care law known as Romneycare. Obamacare wasn’t far behind.

Liberals are wrong to say Republicans don’t have any health care plans today. But they haven’t coalesced around a single one. Part of this has been by design: once you have settled on a specific plan, it is easier to attack. Part of this has also been the product of legitimate policy differences.

Republicans remain divided on how completely Obamacare must be torn up and on how competitive any alternative must be with Obamacare in terms of the number of Americans covered. Conservatives remain confident that there can be better markets for health insurance than the exchanges as presently constructed and certainly higher quality coverage than rickety Medicaid, which is currently driving most of the coverage gains under Obamacare.

But at this point, voters won’t believe them until they see it.

W. James Antle III is politics editor of the Washington Examiner and author of the book Devouring Freedom: Can Big Government Ever Be Stopped? He tweets at @jimantle.