Peter Suderman is a senior editor at Reason magazine.

The GOP still has no idea what a health care victory looks like. The reason the party fails over and over again is Republican health plans are the policy equivalent of what the tech industry calls vaporware—products that are perpetually in development, and are sometimes even previewed or demonstrated, but never quite make it to market. This is the way it always is for Republicans and health policy: a handful of options but no consensus—and the real plan, whatever it turns out to be, is coming soon, but not yet.

Regardless of how the Supreme Court decides this month on King v. Burwell, which challenges the legality of the administration’s decision to allow private insurance subsidies in federally run exchanges, what the episode reveals, yet again, is the Republican party’s historic failure to truly engage with the difficult realities and trade-offs of health policy—and how that failure has crippled the party’s ability to respond even when faced with events like big Supreme Court decisions that should force them to come up with an actual plan.


It may be that the Court rules against the administration, and perhaps even that Republicans manage to capitalize on the moment politically.

But in another sense, Republicans have already lost, because when it comes to larger health policy goals, the party effectively doesn’t have any beyond the repeal of the Obamacare. In the long term, Republicans can't win this fight because they don't know what winning means.

For years, Republicans have promised in no uncertain terms that an Obamacare replacement was just around the corner. “We want to repeal today so that we can begin to replace tomorrow,” Rep. Joe Barton (R-Texas) said in January, 2011, after Republicans took back the House and voted on the first of what would eventually become at least 40 of votes to repeal the health law. The votes helped keep the party’s Obamacare opposition in the news, but practically speaking they were largely theatrical; even if a repeal bill somehow passed in the Senate, it would always be doomed thanks to President Obama’s veto.

“Repeal means paving the way for better solutions that will lower the cost without destroying jobs or bankrupting our government,” said Speaker John Boehner when Republicans took control of the House. Multiple committees were tasked with drawing up replacement options, and they promised to be quick about their work. “We expect them to act in an efficient way,” said Boehner. But those better solutions never materialized—even when the party was given a prime opportunity to do so.

The following year, as a case challenging the constitutionality of Obamacare’s individual mandate made its way to the Supreme Court, Republicans once again promised that a replacement plan was on the way.

"We will be ready to respond to the Supreme Court decision, which is expected in June, with a replacement package," Rep. Joe Pitts (R-Pa.), head of the Energy and Commerce Committee promised in January, 2012. The Supreme Court’s big ruling arrived, but the promised replacements remained somewhere over the horizon, just out of sight. Meanwhile, Republicans kept voting—and voting and voting and voting—to repeal the law.

Now, with the King decision about to land, Republicans are still promising that a replacement plan is imminent. In the months since the Court announced that it would take the case, Republicans, who have generally supported the challengers, have repeatedly claimed that they would be ready should the administration lose.

Initially it looked at least possible that some sort of plan might be in the works. But as the months dragged on, it’s become clear that nothing has changed.

In March, Rep. Paul Ryan (R-Wisc.), the Republican Chairman of the House Ways and Means Committee, promised that he would have a bill ready and scored by the Congressional Budget Office by late June when the decision arrived. “We have to be prepared, by the time the ruling comes, to have something. Not months later,” he said. Yet when Ryan finally unveiled the outlines of a plan last Wednesday, he provided few details, and no legislation or CBO score.

The story is similar in the Senate. In March, GOP senators John Barasso, Lamar Alexander and Orrin Hatch (R-Utah) announced in The Washington Post that they were ready with “a plan to create a bridge away from Obamacare.” The workings of the plan had been widely discussed, the op-ed declared, and “there is a great deal of consensus on how to proceed.”

But after a briefing for Republican Senators last week, two other Republican Senators—Lindsey Graham and John Cornyn—said flatly that there was no consensus about what to do. A separate plan from Sen. Ron Johnson seemed to be gaining steam, but no one knew for sure whether it could pass. Even if the Senate GOP had come to an agreement, there was no sense of whether it could reconcile its likely differences with any potential House plan. The trio behind the Post op-ed, two of whom led the Senate briefing, were reduced to insisting that upper chamber Republicans had considered multiple options and were still working their way to a solution.

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The GOP’s failure to engage proactively with health policy has become more apparent in the Obama era, as the Affordable Care Act has taken hold, but it goes back long before that. Its modern incarnation arguably starts with the collapse of the Clinton health care plan in the early 90s.

What Republicans learned from the defeat of the Clinton plan was that they could win health care debates by refusing to provide an alternative. An enormously influential 1993 memo from Bill Kristol cautioned Republicans to avoid the temptation to “[help] the president ‘do something’” on health care, which would only lend credence to the Democratic idea that the system was broken. Instead, Kristol advised Republicans to question reforms that would upset a system with which a majority of the middle class was already satisfied, and to concentrate on tweaking the system as it already existed.

The result was that many Republicans in Congress walked away under the impression that the American health care system was largely fine, and that doing something to significantly redirect it would only serve the other party’s interests. And so in the decade and a half after the collapse of the Clinton plan, Republicans, on the whole, were largely content to ignore health policy.

Democrats, in contrast, used the time between the demise of the Clinton plan and the election of Barack Obama to regroup and rebuild, with a focus on overcoming the specific challenges that doomed the 1993 effort. The Congressional Budget Office (CBO) scored the Clinton plan as an increase in the near-term deficit, with health premiums counted as government spending, so Democrats, starting with Sen. Ron Wyden, worked with the CBO to craft legislation that the CBO could score as deficit neutral, and premiums kept off the government tabs. The Clinton plan was widely criticized for causing people to lose their doctors and health care plans, so Democrats worked out legislation that President Obama could plausibly—if not, it turns out, accurately—promise would allow anyone who wanted to keep their current plan to do so. The Clinton plan was assailed by a mountain of industry funded ads opposing the proposal, so one of the first orders of business in crafting Obamacare was to negotiate support from doctors, hospitals and health insurers.

Planning for what would eventually become the Affordable Care Act begun not only prior to President Obama taking office but before he even won the nomination. As John McDonough, an influential health policy adviser to former Democratic Sen. Edward Kennedy, notes in his 2011 book Inside National Health Reform, the effort began in earnest in April, 2008, when a group of forty-some veteran health wonks, most of whom had worked on the Clinton health plan in the early 1990s, met in Saint Paul, Minnesota to discuss the prospects for overhauling the health care system. Not everyone was sure that it would succeed, but, importantly, all three Democratic presidential candidates had “produced similar reform plans.” The party had settled on a unified vision, and had even managed a general agreement about the particulars.

Obamacare, in other words, was ClintonCare’s second act—the culmination of more than 15 years of work and consensus building. To put it another way: Republicans never started working on health policy; Democrats never stopped.

It’s not that no one on the right has ever expended any effort on health care. In its latter years, for example, the George W. Bush administration publicly pursued a health care tax deduction designed to make insurance more affordable. But between the collapse of the Clinton plan and the start of the Obama era, health care was never the priority for the GOP. Tellingly, the federal GOP’s biggest contributions during that time frame were to help create the Medicaid sister program CHIP (Children’s Health Insurance Program) in 1997 and add an unfunded prescription benefit to Medicare in 2003. As per the Kristol memo, the party was focused on expanding and shoring up the existing system rather than developing their own big-picture vision for what it should ideally look like.

To be sure, there’s been a flowering of conservative health plans in recent years, and a debate on the sidelines; journalist Philip Klein’s excellent e-book Overcoming Obamacare summarizes the three major right-of-center schools of thought on how to reform or replace the president’s health law: the “reformers” who want to use Obamacare to remake the rest of the entitlement system, the “replacers” who want to scrap Obamacare’s coverage expansion in favor of somewhat more market-friendly, GOP-devised alternatives and the “restarters” who argue that expanding coverage should take a backseat to making health care and insurance more flexible and affordable.

But with a few exceptions—legislators like Paul Ryan and Tom Price—interest in most of these ideas is limited to a handful of dedicated conservative and libertarian health wonks. How many GOP legislators on Capitol Hill could summarize the basic tenets' three major camps, and the debate between the three?

More typical are remarks like those from Rep. Pete Sessions (R-Texas), who in a 2013 floor speech made the strange and incoherent argument that Medicare (an entirely federal program) and Medicaid (which is partially funded by states) were too expensive because the federal government wasn’t paying enough, and also that Obamacare couldn’t work because it interfered with America’s vibrant free-enterprise health care system.

It’s still entirely possible, of course, that Republicans will come together to pass some sort of response bill should the Supreme Court rule against the administration. But even those plans are arguably just new ways to put off the hard work of figuring out what should come next.

Paul Ryan’s plan would sunset in 2017, according to a summary in National Journal, “compelling a new Congress and president to come up with a comprehensive Obamacare replacement”—the same replacement that Congressional Republicans have been promising for years. (And this ignores the fact that any GOP bill along the lines that Ryan has suggested is likely to face a presidential veto.)

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Republicans are talking up their potential response in part because they’re nervous about what might happen if the Court rules against the administration in King. The fact that they’re anxious, and that the post-ruling politics are so unclear, shows just how big a hole they’ve dug for themselves: A Supreme Court ruling on a still-dysfunctional, consistently unpopular law that declares, essentially, that the administration’s implementation has been illegal should be an easy win for Republicans—or at the very least an opportunity to make a strong case for a different sort of reform to the system.

Obamacare is an exceedingly complex, poorly drafted law built atop the shaky superstructure of the existing, deeply fragmented American health system, with its separate tracks for individual, employer and government-run coverage. A better plan could sweep away much of the old mess and begin to unify the system: It would expand coverage and access to care by making it truly cheaper for everyone instead of increasing the cost and adding subsidies, and it would free American medicine from its current tangle of price controls, provider rules and patient regulations while reducing the government’s long-term fiscal problems in ways that don’t rely on uncertain savings from dubious technocratic payment systems.

But Republicans can’t make the case for that plan because they’ve never figured out what it would look like. The GOP plan is always in development but never ready for final release.

That doesn’t mean there’s no hope. One of the most notable pieces of vaporware in tech industry history was Apple’s W.A.L.T., a combination tablet, PDA and fax machine prototyped in the early 1990s but never released. The idea for a device that combined all those functions wasn’t well enough developed or executed, and the public didn’t really understand the product. Yet a little more than decade later Apple released the iPhone and changed the world.

Just because the GOP health care plan is vaporware now, in other words, doesn’t mean it has to stay that way forever.