Would it come as a surprise to learn that the basic structure of the Affordable Care Act, a/k/a Obamacare, is based on a Republican plan that was first floated back in 1993-1994 as an alternative to health care proposals coming out of the Clinton Administration?

That Republican plan was built around an individual mandate and private insurance exchanges, both of which ended up as basic features of the ACA, and both of which are being lambasted today by Republican members of Congress in their effort to drive the final nails into that legislation’s coffin.

What is largely forgotten is the fact that the Democrat majorities in the House and Senate at the time were not enthused about either feature. Many would have preferred a single payer system, or at least a public insurance option that would operate outside of the private exchanges.

There was actually an informal bipartisan “Gang of Six” who worked through the summer of 2009 to flesh out a plan based on the earlier Republican-based proposal.

At the time, President Obama wanted to find common ground with Republicans, and thought that it was more likely to gain some measure of Republican support using a model they had originally supported rather than presenting something entirely new.

The bipartisan approach began to sour as fall approached. Republican Senate Leader Mitch McConnell warned Republican senators on the Gang of Six that their political futures would be in jeopardy if they worked towards legislation that would give the new president a “win.”

This warning was consistent with McConnell’s publicly stated goal to deny Obama any political victories in order to assure that he would not win re-election.

Despite growing partisan opposition, led by McConnell in the Senate, and then Congressman Eric Cantor in the House, debate on the bill proceeded.

In June and July of 2009, the Democrat-controlled Senate Health Committee heard 60 hours of testimony over 13 days as it marked up the ACA legislation.

In September and October, the Senate Finance Committee spent eight days marking up the bill. By the end, 130 amendments, submitted by both Democrats and Republicans, were entertained, and more than 79 roll call votes taken.

Finally, there was Senate debate on the bill for 25 straight days before the bill was finally passed on Dec. 24, 2009.

In the end, every single Republican in the Senate voted against the bill, not necessarily on its merits, but for political reasons. McConnell was reported as saying, “It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bi-partisan, it tended to convey to the public that this is O.K., they must have figured it out.”

The Republican caucus fell into lock step behind their leadership – and remains there today.

Memories are short, and political memories are the shortest of all. For that reason, a walk down memory lane is not out of order.

As Republican leadership lacerates the ACA, folks might want to remember its basic features – the individual mandate and private insurance exchanges – were Republican ideas in the first place.

As a political weapon, McConnell’s obstructionism was a master stroke. “Repeal Obamacare” became a battle cry that served the GOP well in 2010, 2012, 2014, and 2016. For the Republican caucus, the problem is that after beating that particular horse for seven years, it is painfully obvious they have nothing better to offer – even when McConnell is able to craft a so-called “repeal and replace” almost totally in secret.

That is, unless you consider 22 million American losing health insurance, draconian cuts in Medicaid, higher premiums, and lesser coverage, to be progress.

As to the House version, even President Trump labeled it as “mean.” Arguably, the Senate version is even meaner.

We are told the ACA is in a death spiral, and that is probably true. It is not perfect – and no one says it is, or ever was. In the face of continued Republican intransigence, no fixes are likely. However, when they do the autopsy, they will find that foul play was involved.

The ACA did not die a natural death. It was murdered, with premeditation, by politicians who never wanted to see it to succeed in the first place.

(In writing this column, I am much indebted to the historical perspective provided in an article by Norm Ornstein, which ran in the July 6, 2015, issue of The Atlantic magazine.)

 

 

 

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