North by Northwestern

Graphic by Savannah Christensen / North by Northwestern

In the first 100 days of his presidency, Barack Obama had several accomplishments. He shepherded the economic stimulus bill through the House and Senate. He signed the Lilly Ledbetter Fair Pay Act, which restored protection against pay discrimination. He lifted the federal ban on stem cell research. However, he had not yet gotten Obamacare passed.

In the first 100 days of his presidency, Donald Trump has had several accomplishments as well. He successfully nominated Neil Gorsuch to the Supreme Court. He worked with Congress to dismantle numerous regulations on everything from the environment to the selling of personal data by internet providers put in place by President Obama during his final months. However, Trump has not yet repealed and replaced Obamacare.

He’s made some progress, yes. He signed an executive order telling government agencies to ease the "burden” of Obamacare on his first day. The Senate passed a resolution allowing the repeal of Obamacare through budget reconciliation, which means Senate Republicans can push the bill through without a filibuster.

But that’s not close to a full repeal. During his campaign, Trump repeatedly promised that getting rid of the Affordable Care Act, or ACA, would be done on day one. However, to quote the president, healthcare legislation is not easy.

"Now, I have to tell you, it's an unbelievably complex subject," Trump said during a Feb. 27 meeting with Congressional Republicans. "Nobody knew health care could be so complicated."

It’s so complicated, in fact, that the Affordable Care Act wasn’t an easy feat for Obama either. The ACA was not signed into law until March 23, 2010, or over two years into Obama’s presidency.

But Trump and the Republicans made a promise. And thus, they brought forward the American Health Care Act. And there was a lot of drama.

The bill was first locked away from both Republicans and Democrats in the basement of congress. House Speaker Paul Ryan tried to rush it through without a Congressional Budget Office (CBO) score that would make the bill look bad. But the CBO score came out. And it was positive, as in the bill would not increase the deficit. But it was negative in many other ways.

According to the CBO, the AHCA would have repealed the individual mandate requiring all Americans to have health insurance or pay a penalty, repealed the Medicaid expansion, offered more financial assistance to young people and less to the elderly and caused premiums to rise and then fall. But not for everyone. Elderly Americans could be charged five times more than younger people, up from Obamacare’s three. The AHCA would also have left 24 million Americans without insurance by 2026.

It was also unpopular with the House’s extremely far-right Freedom Caucus, which was angry that the bill wasn’t a full repeal, and moderate Senate Republicans, who believed that the bill went too far. Talks resulted in a new version of the ACHA to bridge that gap, and the CBO gave that new version a worse score. Last minute talks to reconcile the two groups broke down. All this culminated in Ryan pulling the bill just a few hours before the scheduled house vote.

According to Northwestern Political Science Professor Laurel Harbridge Yong, the bill’s failure came about in a big way, thanks to the gap in what congressional Republicans wanted. “I haven’t seen anything that would suggest you can achieve all of those things at once,” she said. “I’ve always been a little bit sceptical over Trump’s claims that they’d have a proposal that would cover everyone and would cost less, because I haven’t seen anything in policy details that would do that. If there’s something out there, then by all means they should go for it.”

The bill also had a 17 percent approval rating, according to a Quinnipiac University poll. So there’s that. In addition, the ACA hit its highest popularity ever in January 2017.

So, why did the Republicans run into so much trouble, especially compared to the more than 50 times they voted to repeal the ACA when Obama was president? Yong says the Republican transition from an opposition party to a governing party didn’t help.

“A lot of times when a party knows that something will not pass, they can propose and pass legislation for largely symbolic reasons,” Yong said. “However, when the chance of passing it actually increases and you’re therefore going to be on the hook for whatever comes from it, now the members care a lot more about what’s actually in the bill and what the consequences would be on their constituents.”

After Ryan pulled the bill, he gave a press conference unthinkable just a week before. Now, Obamacare “was the law of the land” and would be sticking around.

“It's gonna remain the law of the land until it's replaced,” Ryan said. “We did not have quite the votes to replace this law. And, so, yeah, we're going to be living with Obamacare for the foreseeable future.”

But what does the bill’s failure mean for the future of Obamacare? Yong doesn’t expect this to be the Republicans' last word. First, there’s pleasing the base. And the AHCA’s proposed tax cuts would go a long way to helping the Republicans achieve tax reform. Plus, huge legislative achievements usually take longer than the first 100 days.

“I certainly think that it’s still possible for Trump and the Republicans to kind of right their ship and have some major legislative successes,” Yong said. “They essentially set themselves up to fail. They said they were going to do this on day one, and they’ve had 6 years to come up with a bill.”