Republicans' failure to repeal Obamacare, or even make major changes to it, feels overdetermined. They came into the debate holding a weak hand, and they played it badly.
1. Voters have feared every attempt by politicians to change their health care arrangements.
That sentiment helped defeat President Bill Clinton's proposed overhaul in 1994. It forced President Barack Obama to devote half his sales job on his health care law to reassuring people they could keep their doctors and insurance plans. This year, public wariness of change worked against the Republicans.
2. Democrats and the press played up how disruptive Republican legislation would be.
They frequently said Republican bills would "take away" insurance from millions of people, citing the Congressional Budget Office.
That was a distortion. Under each bill the majority of those millions would have been people voluntarily forgoing insurance after the abolition of Obamacare's fines for people who make that decision. A lot of the other people affected were in states that, the CBO guessed, might expand their Medicaid programs in the future if Obamacare stays. Still, Republicans did very little to try to correct the record.
3. One reason Republican politicians did not engage on the issue effectively is that, as a rule, they neither know nor care much about health policy.
Historically they have seen the issue as a Democratic strength, to be avoided while they stay on their own safe ground of taxes, regulation and military readiness.
4. Republicans avoided multiple opportunities to reach a consensus on how to replace Obamacare.
Some Republican officials put forward plans in 2013 and 2014, but party leaders refused to embrace them on the grounds that candidates were better off being vague and the party's presidential nominee would lead on the issue. This advice suited a party averse to thinking about health care.
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