Chris Jacobs thinks it is interesting that he is talking about the anniversary of the Affordable Care Act (ACA) as Congress scrambles to combat the COVID-19 outbreak.
That’s because the ACA was drafted during the Great Recession that was griping markets and causing the unemployment rate to skyrocket.
“There were a lot of folks on the conservative side and independents [asking], 'Why are you trying to pass this legislation during a huge economic crisis?'” said Jacobs, a healthcare policy expert who frequently writes for The Federalist and is the head of policy firm Juniper Research Group.
He added that if President Donald Trump tried to move an immigration bill now or Democrats pursued a massive bill, there would “be similar concerns that you should be spending your time focused on the immediate problem” of the coronavirus pandemic.
Conservative opposition to the ACA has been stalwart since the law was passed 10 years ago. The ACA’s passage was a big catalyst for the creation of the Tea Party movement, and repeal of the law served as a rallying cry that propelled major congressional victories in 2010, 2014 and 2016.
Jacobs was working for Mike Pence when the current vice president served in the House in 2009 as the ACA’s package was being debated.
“Everybody on Capitol Hill was spending time talking about healthcare and the unemployment rate kept going up throughout 2009,” Jacobs recalled. “Why are you doing this now?”
Jacobs said that the timing of the law played a major part in the backlash that grew among conservatives in addition to major philosophical clashes with the scale of government intervention and spending.
Opposition to the law benefited Republicans at the ballot box, leading to a wave of Republican victories and control of the House in 2010.
When House Republicans took over in 2011, they started to hold a series of hearings on the law. That trend continued as the Obama administration botched the rollout of HealthCare.gov in 2013.
“They didn’t have hearings on the law after it was passed and so really only once Republicans took over the majority in the House in 2011 that is when Democrats said, ‘We will have to somewhat defend this law,’” Jacobs said.
Things changed for Republicans after the 2016 presidential election, which led to complete GOP control of Washington.
But it also brought forth an uncomfortable truth about Republican opposition to the law and what to do next.
“Repeal and replace was a slogan, it wasn’t a policy,” Jacobs said. “You had the repealers who wanted to get rid of the law and focus primarily on costs and containing costs and that is about it. Then you had the replacers which were focused on 'We can keep all the good parts of the law and get rid of the bad parts of the law.'”
The ”disparate philosophies” were going to be difficult when legislation actually had to be hammered out, said Jacobs, who recently published a book called "The Case Against Single Payer" that touches on the latest healthcare fight that is embroiling Capitol Hill.
The House GOP leadership put out a bill in March 2017 called the American Health Care Act that didn’t touch parts of the law that targeted preexisting conditions. That sparked a revolt among the hard-line conservative House Freedom Caucus that temporarily scrapped the bill.
Republicans eventually brought the bill back up in the spring with a compromise that got the Freedom Caucus on board but opened up Republicans to attacks that they were curbing preexisting condition protections.
The bill was scrapped by the Senate, which famously couldn’t agree on its own legislation.
“It didn’t surprise me when the effort ended up collapsing,” Jacobs said. “I was more surprised that the consensus was after 2016 election people thought it would be able to get Rand Paul and Susan Collins to agree on a strategy in terms of replacing the law.”