When you stake your entire political being on the repeal of one legislative act, and you keep banging that drum for six or seven years, you paint yourself into a corner.
The Republican efforts to repeal the Affordable Care Act, also known as Obamacare, have come to this: With control of the White House and majorities in both the House and the Senate, Republicans can do what they have tried to do dozens of times since 2010 — repeal the Affordable Care Act. Doing so, the GOP leaders remind their colleagues persistently, carries out a long-standing campaign promise repeated during four congressional elections. Failure to keep their promise about repeal would reveal them as ineffective, or as Spiro Agnew might have said it, "effete snobs."
The problem, which the GOP leadership ignored for seven years, is that American voters care more about their health care than they do about campaign promises. And many Americans, despite Republican attempts to persuade them otherwise, liked the ACA. It made it possible for them to have health insurance for the first time in years. The percentage of covered Americans topped 90%.
So the GOP leadership backed off a little. Instead of just repealing Obamacare, they shifted their rhetoric to "repeal and replace" Obamacare. Replacing the expansive law was not so easy. As President Trump confessed, "who knew" health insurance could be so complicated?
Republicans now have two Obamacare replacement bills, one in the House and one in the Senate. Both would sharply curtail the ACA promise to make it possible to get insurance coverage if you have a pre-existing condition. Both would knock down the fiscal underpinning of the ACA, the taxes on medical devices, insurers and others, and both would sharply cut Medicaid, which millions of Americans depend upon.
Republicans may have the votes in the Senate to pass their replacement legislation, but they don't have the magical ability to persuade Americans struggling to find medical coverage that they are better off with the Republican solutions to that campaign promise the GOP had kept making over and over like a mantra. Because of those promises, the GOP could not do the sensible thing, which would be to make adjustments to Obamacare so that it is more fiscally stable and practical.