The Meaning of the GOP’s Latest Obamacare Surrender

B eneath the placid surface of this year’s largely successful Republican National Convention, some discontent has lurked. Occasionally, it has come into public view. Consider the new Republican Party platform. The platform heavily bears the imprint of Donald Trump, now firmly ensconced as the party’s leader, even down to its bullet points and serial capitalizations.

But it’s a Trumpian platform in more than just style. The substance also reflects his vision for the party. Conservatives have already noticed its moderation on abortion and marriage versus past platforms. Less remarked upon is the lack of any mention of a government program that conservatives had opposed since the early years of the Obama presidency, before it was even passed: the Affordable Care Act, a.k.a. Obamacare. The apparent absence of official opposition to Obamacare comes as the program continues to distort our health-care system and serve the Left in the culture war. It also raises the worrying possibility that Republican concern for limited government and traditional values will atrophy in tandem.

You don’t have to be an old-timer to remember the intense political battle over Obamacare. A drastic extension — between its individual mandate to purchase health care, health exchanges, and expansion of Medicaid, and other features — of government control over the American health-care system, it was Obama’s signature domestic-policy achievement. But that achievement was in no way guaranteed. It occasioned a raucous contest, both before and after it became law in March 2010.

Opposition motivated the limited-government Tea Party movement, which helped Republicans win a historic victory in the 2010 midterms. The program — and its possible repeal — then became a significant issue in the 2012 Republican presidential primary. Ultimate victor Mitt Romney, whose Massachusetts health-care reform as governor inspired Obamacare, was a flawed standard-bearer for this opposition. Yet he continued to campaign against the program when the Supreme Court, in a bizarre opinion authored by Chief Justice John Roberts, upheld the individual mandate as a tax. Romney’s critique of Obamacare was an important part of his momentous performance against Obama in the first presidential debate of 2012.

Though Republicans lost that year’s presidential election, their opposition to Obamacare persisted. As the program unfolded, its full designs (such as the contraception mandate, which led to a government lawsuit against the Little Sisters of the Poor, a group of nuns who declined to provide abortifacient drugs) and flaws (such as its malfunctioning website) continued to vindicate and energize critics. In 2013, Texas Republican senator Ted Cruz attempted (unsuccessfully) to filibuster it into oblivion. Republicans in the House had voted to repeal or seriously change the program dozens of times by March 2014; Republicans won control of the Senate later that year. Repeal was still a live issue by the 2016 primaries. Even Donald Trump, in many ways an unusual candidate at the time, still felt the need to promise to get rid of Obamacare and replace it with “something terrific.”

Republicans got their chance after the 2016 elections unexpectedly gave them control of the presidency and both chambers of Congress. But the years since 2010 proved to have been spent more in opposition than in preparation. A political debacle with many fathers ensued, as competing repeal-and-replace plans came and went, none able to secure a necessary majority. Trump mused, “Nobody knew health care could be so complicated.” Republicans had to settle for zeroing out the individual mandate in the Tax Cuts and Jobs Act in 2017, Trump’s primary legislative achievement. Today, some Republicans, including Trump, still make occasional noises about getting rid of Obamacare. But the record of the past decade-plus makes it hard to take them seriously.

The new party platform makes it harder still. The 2016 platform bluntly stated that “any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare,” and further criticized the program throughout; the 2020 platform readopted 2016’s. Compare the 2024 platform’s section on health care: “Healthcare and prescription drug costs are out of control. Republicans will increase Transparency, promote Choice and Competition, and expand access to new Affordable Healthcare and prescription drug options.” Obamacare is not even mentioned. And the platform’s promise to “fight for and protect Social Security and Medicare with no cuts, including no changes to the retirement age,” bespeaks a mindset protective of government entitlements that can extend easily to Obamacare. The program’s proponents were, of course, hoping all along that it would become part of the seemingly unassailable bedrock of government in public life, further increasing the dependence of citizens on the state. They seem to have gotten their wish, with little lingering protest from Republicans.

It would be one thing if this lack of concern came as Obamacare were sinking, regretfully yet placidly, into the bureaucratic background, hardly to be noticed. But it isn’t. President Joe Biden (rightly, if for the wrong reasons) called Obamacare’s passage a “big f***ing deal” as Obama’s vice president. Recent legislation that loosened income-eligibility requirements for subsidies to enroll in the exchanges set up by the program have led to fraudulent enrollment and will cost taxpayers $15 billion to $20 billion this year alone at least, according to the Paragon Institute. Those subsidies are gobbled up by insurance companies. And earlier this year, Biden unilaterally enrolled 100,000 illegal immigrants in Obamacare. Obamacare is now an even bigger deal.

It’s not just a fiscal problem. Democrats have used Obamacare to implement cultural progressivism as well. The treatment of the Little Sisters of the Poor is just one example. The 2022 Inflation Reduction Act increased subsidies for health-insurance plans on the Obamacare exchanges that fund abortion on demand. And this past May, the Biden administration restored an Obamacare provision (removed by the Trump administration) that redefined “sex” to include “gender identity” and “termination of pregnancy” for nondiscrimination purposes.

Some Republicans still genuinely care about Obamacare’s continuing distortions. In a recent speech, Rachel Bovard of the Conservative Partnership Institute rightly lamented “the failure of Obamacare.” But, on the whole, the Right seems to have given up. In 2019, J. D. Vance, now the Republican vice-presidential nominee, even said he’s glad Republicans failed to repeal Obamacare; he has shown little appetite for doing so since. (Vance has also assented to Trump’s moderation on abortion.)

Some internal critics of the Right’s trajectory over the past few decades have decried its record of losing to the Left. Some have blamed excessive devotion to limited government. But the truth is found below such surface superficialities. Obamacare shows that big government and progressivism go hand in hand. And the Republican platform provides more evidence that abandoning limited government goes hand in hand with abandoning traditional values. True conservatives who still care about both have a lot of work to do.