When President Barack Obama was first sworn into office in January 2009, he immediately began the process for passing his key policy issue - reforming the country’s expensive and haphazard health insurance industry. The Patient Protection and Affordable Care Act, which would eventually be known as the Affordable Care Act, the ACA, or simply “Obamacare,” was then introduced in the fall of 2009. By November, it passed with a mere five-vote majority in the House, and the following month, it passed the Senate 60 to 39.
In both chambers, not one single Republican voted in favor of the bill.
It didn’t have to be that way. Health-care reform was an issue both parties were in favor of and previous efforts had enjoyed bipartisan support. The most hopeful-looking option was the “Healthy Americans Act,” a reform bill introduced by Sen. Ron Wyden, a Democrat from Oregon, and Sen. Robert Bennett, a Republican from Utah. The 2007 bill had multiple co-sponsors on both sides of the aisle but never managed to make it out of committee.
Still, when it came to the Affordable Care Act, Republican politicians were lockstep in their refusal to so much as consider any sort of common ground - even though many aspects of the plan were quite similar to a 2006 Massachusetts law developed and signed by Republican Gov. Mitt Romney. Their opposition was immediate, total, and relentless, to the point where many find themselves wondering just what do they hate so much about Obamacare?
Based solely on official conservative principles, there are actually a number of issues that the GOP legitimately would have with the ACA. Just like Social Security, Medicaid, and Medicare, they view Obamacare as an entitlement program they would be more than happy to discontinue, believing that the government should never be involved in assuring minimum standards of living are met. “[S]ome conservatives oppose it for the same reason that liberals favor it. Through the Medicaid expansion and the exchanges, it subsidizes insurance coverage for people of modest means by raising taxes on people of less-modest means,” explains Reilhan Salam at Slate, adding, “Conservatives tend not to be enthusiastic about redistribution, and they’re particularly skeptical about redistribution that isn’t transparent.”
The industry regulations that are a part of the Affordable Care Act are also another stumbling block for fiscal conservatives who believe that businesses should always be allowed to govern themselves and are justified in gaining as much profit as they can for shareholders. As part of health-care reform, insurance agencies were forced to spend 85 percent of all revenues on medical care rather than administration costs or bonuses or perks. They could also no longer cap how much they spend per patient in coverage due to medical conditions or other need for chronic care, either on an annual or lifetime basis. These restrictions on profitability are opposed by Republicans who think free market principles will keep businesses in check.
And of course there were issues with reproductive health care such as abortion and birth control. Anti-abortion groups claimed the Affordable Care Act to be “the largest expansion of abortion since Roe v. Wade” due to the inclusion of some insurance plans in the exchange that allowed coverage for elective abortions. They considered plans purchased on state and federal exchanges to be a means of forcing other taxpayers to “subsidize” elective abortion coverage, despite the fact that the government set up additional steps to ensure that federal funding to private insurance plans that cover abortions remain separate, and the president’s additional executive order reaffirming the Hyde Amendment’s federal ban on abortion funding. They also demanded exceptions for all companies - for-profit and nonprofit - who had religious objections to birth control. The birth control mandate declared contraception an essential service for women’s health and required all companies to offer plans that included hormonal birth control, emergency contraception, long-acting birth control methods, and female sterilization procedures. Religious institutions were allowed a conscientious objection to the coverage, but social conservatives wanted the loophole extended to any business or organization whose owners disapproved of any birth control use for moral reasons – regardless of how many of their own employees or other insurees may have different opinions on the issue.
Yet while the GOP has strenuously opposed all of these individual aspects of the ACA, it was the individual mandate that appeared to irk them the most - and had the least reason to do so. Republicans, using language that originated with the conservative Heritage Institute, were advocating for a requirement that all people be required some form of health insurance as long ago as the late 1980s and it was championed by GOP Congress members during much of the early 1990s. It was even a key component in the Massachusetts health care law approved by Gov. Romney in 2006. But the individual mandate instead went from being something that Republicans were willing to support in order to bring down the costs of insurance to a policy they claim strips personal liberty and is even tantamount to slavery.
So what flipped the switch? Election Day, 2008. When Obama won his first presidential election, that also put both the House and Senate into Democratic control. The House Democrats outnumbered Republicans 257 to 178, and Democrats and their two independent allies outnumbered the Senate Republicans 59 to 41. According to the Brookings Institute’s Thomas Mann, GOP strategy experts decided that the best way to win back majorities would be to keep their entire conservative block united in rejecting any legislation that could potentially be viewed as a Democratic success if it passed. Congressional Republicans were urged to filibuster any bill that came before the Senate and harshly criticize any law that they couldn’t stop in an attempt to make what did pass as unpopular as possible. That decision doomed any chance for bipartisan health-care reform.
The GOP’s refusal to vote in favor of Obamacare’s passage and their aggressive opposition to every element of the bill - even those they had agreed with in the past - served to help them sweep into power in both Congress and a number of state legislatures when the 2010 midterms came around. And by taking over a number of state legislatures and governors’ mansions, Republicans could then block portions of the ACA from going into effect, further hampering the reforms. Red-state legislatures often refused to expand Medicaid so more people could receive subsidized insurance plans, leaving their residents with far more expensive out-of-pocket costs than blue-state counterparts. They also often opted out of opening their own state exchanges, forcing the uninsured to enroll through the federal exchange instead, which limited their coverage options and put a greater burden on the federal site. By first refusing to support Obamacare and then purposefully trying to make it fail, Republicans believed any consumer dissatisfaction would rest completely on the shoulders of the Democrats, since they were the only ones to vote in favor of the law.
So do Republicans really despise the Affordable Care Act? Despite the fact that they have voted in some way, shape, or form to repeal some or all of the ACA more than 60 times in the six years since it was signed into law, the answer may surprisingly be no. Or at least, not as much of it as they claim. But they do hate the “Obamacare” that was passed solely with Democratic votes and signed by a Democratic president, and they will do anything to tear that down completely. And when they later replace it with a new plan that has a surprising number of policies similar to the law they just undid, well, then we will know the thing they hated most about Obamacare was always Obama.
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