I remember where I was and how it felt when the House of Representatives held the deciding vote to establish the Affordable Care Act. It was a feeling of elation, but, sitting in my living room by myself, an oddly solitary one. I ran out into the street of my residential neighborhood, half-expecting jubilant V-J Day–style crowds. But it wasn’t just that my neighbors were at work. The months and months of legislative grinding had cast a pall of depression over even many enthusiastic Obama-voting liberals, who saw the health care law as hardly worth celebrating.
The death of Obamacare repeal, in the early morning hours of Friday, July 28, was a very different experience. “Nothing in life is so exhilarating,” as Churchill is reputed to have said, “as to be shot at without result.” Obamacare has gained not only positive approval in broad opinion polls but a genuine mass following. Hundreds of thousands of Americans rallied to its defense, making its repeal impossibly painful for the Republican government that had once assumed it would sweep the law away in a January lightning strike.
Republicans had spent the last eight years in an unremitting struggle to prevent universal coverage from taking hold. Mitch McConnell applied irresistible pressure on Republicans in Congress not to negotiate with the Democratic majority, to the point where, when President Obama asked Republican senators what they would need to vote for a bill, they could not name anything. Republicans concocted fantastical legal cases, pressured state governments to boycott the law, ran a candidate in 2012 promising to repeal it before its coverage took hold, shut down the government in a fit of rage, spent fortunes in advertisements denouncing it, and declared it a failure when its website initially failed. That it has survived against such fanatical opposition, and committed sabotage, is a testament to the law’s strength.
That commitment to destroy the law became an albatross around the governing party’s neck. Perhaps even more than Trump’s buffoonery, the party’s relentless drive to please its activist and donor base by fulfilling the promise of repeal has broken the faith of the downscale white voters who rely on the law for their access to medical care. The repeal crusade is a fiasco of historic scope, opening the door for Democrats possibly to recapture Congress.
Health-care policy will change. The Trump administration has powerful weapons to sabotage the functioning of the markets. But the world before Obamacare will never return. Health-care reform defied progressives for decades because the uninsured were a disorganized and politically voiceless group. Obamacare has transformed the non-constituency into a constituency. Republicans have had to promise to protect them, and when they tried to break that promise, it summoned a backlash unlike anything they could have imagined. The outpouring of political organizing to save the law shocked its would-be repealers. The movement to save Obamacare takes its place among the great social causes in American history.
By the end, Republicans had given up on phasing out the Medicaid expansion (which accounts for a majority of the new coverage under Obamacare) and lowered their sights to weakening the subsidized exchanges in a roundabout way. Even that proved too difficult. If Donald Trump lashes out and continues to drive insurers from the exchanges, it will only serve to intensify the building wave against his party.
The desire on the right to destroy Obamacare will probably never disappear. In 2005, 70 years after the establishment of Social Security, confident Republicans sought to privatize the hallowed program. That, too, was a painful failure. And there is a lesson in this. While elections swing back and forth between right and left, there is a reason that the United States is a more humane place today than it was 25 or 50 years ago. Social Security, civil rights, Medicare, Medicaid, and Obamacare have survived. Legalized child labor, supply-side economics, and unlimited pollution have withered. Ideas that bring real improvement to peoples’ lives have more staying power than ideas that do not.
Obamacare has brought life-changing access to modern medical care to 20 million Americans. It will endure.
