When Republicans unexpectedly won control of all branches of government in November, it was well understood that they hadn’t done the basic due diligence required to govern. This is what political commentators meant when they deployed the overused metaphor of the dog that caught the car.

The fact that almost everyone in the political world believed Donald Trump would lose the presidency explained the element of surprise. But the belief that he and his party would be unprepared stemmed from a widespread understanding that they had largely ignored for the realities of governing during the Obama years—particularly as pertained to their campaign against the Affordable Care Act.

As soon as the ACA became law in March 2010, Republicans began promising to repeal it, but they knew right away that the facts of the law, like its pre-existing conditions protections, would assert themselves quickly and they would need answers.

My notecard from our March 2010 meeting where "repeal and replace" was born. pic.twitter.com/LOOu3vU9fD — Josh Holmes (@HolmesJosh) January 15, 2017

To say that coining the phrase “repeal and replace” was the full extent of the spadework Republicans have done since then would only be a slight exaggeration, but the truth is, they and everyone else would be better off if it were true. In addition to repeating this hollow slogan, Republicans drew a caricature of the Affordable Care Act based entirely on its shortcomings and tradeoffs; they scrubbed the law’s material benefits from their rhetoric, and made contradictory promises about how they would remedy these problems. These added up to a second caricature of a Republican health care plan that would be somehow cheaper than Obamacare, cover more people, and with better insurance.



House Republicans stand poised on Thursday to pass legislation that would—if it became law itself—expose the falseness of these promises. The fact that they will be voting, by design, without an impact analysis from the Congressional Budget Office (CBO) suggests that at a level of abstraction they know their bill, the American Health Care Act, has its own tradeoffs, all of which come at the expense of the most vulnerable—the sick and old and poor—for the benefit of the healthy and affluent.