Why the Republican Repeal and Replace Plan Collapsed — and Cautions for Dems

[This commentary appeared on July 18 on the WBUR blog page called Cognoscenti.]

As the nation considers the utter collapse of the Better Care Reconciliation Act (BCRA), advanced by Senate Majority Leader Mitch McConnell, to repeal and replace the Affordable Care Act (ACA), some perspective is in order. Since President Trump’s Nov. 8 election, I have heard many people’s distress about the dire threats to the ACA that initially seemed so certain last November.

So, let’s consider…

First, Michael Reich, my colleague at the Harvard T. H. Chan School of Public Health who has worked on national health reforms all over the globe, reminds me that the moment of truth, the acid test, for any health reform happens when the government that created it leaves office and is replaced by a new government, and the new leaders must decide for themselves what will stay or go.

As we have witnessed since November, this is not just a choice for a new administration; it is a choice for Congress and for American society. Since the election, Americans have had to confront a dilemma — namely, what do they care about regarding the Affordable Care Act and what are they prepared to do to defend it?

After the election, with shocking abruptness, polls on the favorability of the Affordable Care Act began to increase after years of being stuck in 40 percent purgatory. Suddenly, Americans began focusing on policies such as banning pre-existing condition exclusions, expanding Medicaid, requiring coverage of essential health benefits such as maternity care, prescription drugs and much more.

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