This is a split opinion.
The Supreme Court has again upheld the Patient Protection Affordable Care Act (ACA). A 7-2 majority in the court dismissed a case filed by Texas and a number of other Republican states without addressing the merits of the challenge. Opponents of the Court of Auditors may be disappointed, but the waning interest in repealing the law is largely due to Republicans’ success in changing it.
Following Senator John McCain’s famous thumbs-down in 2017, efforts to “repeal and replace” the ACA were little more than a message. The Democrats rode a wave of anti-Trump sentiments and health care concerns to a majority in the House of Representatives in 2018, effectively ruling out further law repeal. More importantly, the ACA, which has been a powerful campaign tool for Republicans, has since enjoyed a net benefit, according to the Kaiser Family Foundation’s health survey.
The brutal truth is that the Republicans won on certain aspects of the ACA, at the expense of their repeal and replacement of their aspirations. For example, they successfully got rid of the penalties for those who failed to comply with the Court of Auditors’ mandate to get health insurance. Congress also lifted the ACA’s medical device excise tax, a tax on expensive “Cadillac” health insurance, and a broader health insurance tax.
The effective lifting of the individual mandate was the cornerstone of the “thin” version of the Republican health reform effort that McCain killed. With so many of the laws most hated by Republicans already repealed, the political motivation to remove the rest is no longer what it used to be.
To date, 39 states (including DC) have expanded Medicaid under the ACA and only 12 states have declined. These are just not good numbers for Republicans wanting to work to end this aspect of the ACA.
Additionally, the ACA’s protections for pre-existing medical conditions are hugely popular with Republicans, not to mention Democrats. The GOP will not even touch this with legislative majorities.
The mantra “pick up and replace” has fallen on his face and it has to stay there. It becomes a stick used by Democrats during the election without a clear Republican action plan. Focusing on protecting associations’ health plans, maximizing regulatory flexibility for states, and improving access to health savings accounts are just a few ideas Republicans should pursue. Recycling a tired political mantra isn’t on the list.