The party in power has twice attempted to overhaul health care in the past quarter-century. And both times it ended up with politically catastrophic results. Now, the GOP attempt to replace Obamacare is shaping up to be the defining issue of the 2018 midterm elections — one big enough to rattle the foundations of Donald Trump-era Washington and beyond.

The Republican-controlled House and Senate aren’t all that’s at stake if the president and congressional leaders can’t deliver, nor sell the American public on the new plan. If the 1994 and 2010 midterm elections are any guide, the blast radius of failure could also reach deep into the statehouses.


Bill Clinton’s lead strategist James Carville — who saw the 1993-94 health care battle up close — framed the impending peril for the GOP as inevitable at a private Florida Democratic donor conference in January. “The mover on health care loses,” he said. “To do something is to lose.”

That conclusion was drawn from bitter experience. The ultimately unsuccessful fight Clinton undertook early in his first term contributed to a 1994 scorching that cost Democrats both chambers of Congress, handing the House to Republicans for the first time in nearly a half-century. And the shockwaves rippled well beyond the Beltway: In 1994, Democrats went from control of 29 governors mansions to 19 and lost more than 15 state legislative chambers.

Sixteen years later, passage of Barack Obama’s Affordable Care Act led to similarly disastrous results for Democrats — losses from which the party has yet to recover. In addition to losing the House in 2010, Democrats were forced to watch their 26-24 edge in governorships turn into a 29-20 Republican majority. And Republicans gained nearly 700 seats in state legislatures across the nation.

“It did result in my defeat, and a whole lot of other Democrats in 2010. I don’t think it was the [only] thing, but it was the impetus that got people angry enough that they wanted to throw the bums out,” said former Indiana Rep. Baron Hill, a Democrat who lost his seat in Republicans’ 2010 romp and still defends Obama’s law. “The town hall meetings that these Republicans are having? There’s more energy in our side than in a long, long time, [and] the same ingredients are involved this time around that were around in 2010, and that’s anger. Anger that gets people motivated.”

“We’ve got to remind everybody that Republicans are in total control right now,” he added. “They cannot run away from what they’re doing.”

Republican leaders, naturally, dispute any similarities to previous go-rounds, insisting that the proposal led by House Speaker Paul Ryan is nothing like the efforts from Obama or Clinton — the latter spearheaded by then-first lady Hillary Clinton. Their central message is that, after eight years of trying to repeal the Affordable Care Act, GOP lawmakers are keeping a promise they had been making for four election cycles.

“The difference is the Obamacare legacy has been debated and decided by the voters in 2010, 2014 and 2016,” said Ohio Rep. Steve Stivers, chairman of House Republicans’ campaign arm, who joined Congress in the same election that ousted Hill. “We’ve run on getting rid of Obamacare in 2010, 2014 and 2016, and done pretty well in all those cycles on that. No one with a credible, straight face can say Obama ran on Obamacare in 2008, [so] this has been litigated by the voters, decided by the voters. I’m in the interesting position of having been elected in 2010 due to their overreach on health care and other issues, and that’s why I’ve said we shouldn’t overreach. And I don’t think we have.”

But Republicans concede they’re growing increasingly concerned about falling into familiar political traps. Vulnerable members are beginning to seek distance from the GOP leadership-backed American Health Care Act. Messy intratribal rifts have been exposed. Even Ryan is taking flak: On Monday, hours after the release of a Congressional Budget Office report showing the speaker’s plan would increase the number of uninsured Americans to 24 million by 2026, the alt-right Breitbart News picked a scab by publishing an October recording of Ryan excoriating Trump to Hill Republicans.

All of this is taking place as support for the ACA has been rising in polls and the media focuses on the 24 million projected to lose their health insurance under the GOP’s replacement measure.

“This is all a mess, it’s going to stay a mess, it’s a huge undertaking,” said former House Speaker Newt Gingrich, the leader of 1994’s so-called Republican Revolution. “They have allowed themselves to be trapped by two Washington swamp institutions — reconciliation, as defined by the parliamentarian, and the Congressional Budget Office. It’s very hard to defend Trumpism if you let the swamp define the rules of the game. Health is an immensely difficult area, 10 times more complicated than national security. We’re going to have to muddle through for a while.”

His party, he said, could risk a serious midterm blowback if the health care plan isn’t passed within the year: “By next spring, they have to have a health solution clear enough — and implemented enough — that people feel comfortable.”

Outside Washington, GOP governors — many of them elected as part of the Class of 2010 — sense the danger as well. Despite agreeing in principle with the idea of repealing and replacing Obamacare, few have been willing to vigorously support the AHCA. The GOP will be especially exposed at the state level over the next two years — 27 of 38 Republican-held governors mansions will be be up for election in 2017 and 2018. A handful of them will be in blue states, where phasing out Medicaid coverage will be extremely unpopular.

A central concern among Republican officials both in Washington and in the states is that the health care debate could spiral out of their control, overwhelming the legislative agenda before the party can pass anything else. It’s what happened to Obama and his “hope and change” message back in 2010 when Democrats controlled the House and Senate, and it served as an accelerant to the furious town halls all around the country then — much like today.

“This is the oddity: Republicans criticized Obama for running on jobs and the economy and then coming and doing health care,” said Neera Tanden, a senior health care official in Obama’s administration during the ACA push. “At least President Obama had done a massive stimulus bill [first]. Here, they haven’t passed any major legislation at all. They haven’t done anything related to the economy. Donald Trump has fallen into the precise trap, has decided to do the exact thing Republicans criticized Obama for doing eight years ago.”

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Republican Senate leaders have told their members they want a strict timeline for passing health care reform. That’s what the GOP campaign committees are hoping for — a reasonably quick resolution, allowing the party to return to economic programs that let Trump promote his “jobs, jobs, jobs” message.

The GOP plan’s biggest proponents are eager to downplay its scale, wary of framing it as a sprawling overhaul worthy of a long, drawn-out debate: “We’re trying to respond to a failure of Obamacare, the status quo. It’s ‘do something, or do nothing,’” said Stivers. “We’re doing something, but we’re not doing a radical proposal.”

Paul Starr, Bill Clinton’s senior adviser on the 1993 health care push, sees a political design in the GOP approach — one that is colored by the searing lessons of the 1994 and 2010 elections.

“I don’t really think they care about the specifics so much,” said Starr. “They just want to avoid blowback in the short term so they postpone a lot of the immediate effects, but they’re still really at risk of having the individual insurance markets implode, so they don’t escape that problem.”

Democrats have taken to heart an overriding lesson of 1994 and 2010: that the traditional midterm electoral snapback that affects the president’s party is amplified by the volatility of health care politics. Ads promoted by the Democratic super PAC Priorities USA Action have turned the tables, derisively labeling the GOP plan “Trumpcare.”

A recent memo from the Democratic Senatorial Campaign Committee makes clear the party is counting on another health care political debacle. The title? “The New Healthcare Dynamic: GOP Senate Candidates Own This Plan.”

