People tend to forget this, but health care reform wasn’t just a shiny object on the Democrats’ wish list in 2009; the health care system was creaking, and insurance premiums were soaring, at the time Obama took office.
Obamacare, of course, was based on Romneycare, an approach that had previously enjoyed the support of plenty of Republicans and even the Heritage Foundation. Once Obama’s name was attached to it, however, GOP support for the concept completely vanished.
The legislative process was long and messy, perhaps unnecessarily so. Remembering the Clintons’ grim experience with health care reform, Obama took pains to negotiate with insurance companies and caregivers and gave plenty of authority to Congress to shape the bill instead of presenting legislation and demanding immediate action. Important parts of the bill, such as the public option, fell by the wayside. To make matters worse, the roll-out of the website was mishandled, some of the statements made to support the bill were demonstrably untrue, and the Supreme Court limited the scope of the bill in a terrible decision which made the Medicaid expansion optional. Republican voters hated the program because they viewed it as just another redistribution/entitlement goody bag for the undeserving poor. Consumers complained about rising costs and limited benefits. On the whole, therefore, it was a political liability for the administration and for Democrats in general.
From a policy perspective, Obamacare has been a qualified success; the uninsured rate has fallen significantly, and the medical cost curve was bent. The GOP alternatives to it all benefit the healthy and the wealthy at the expense of the poor and the medically needy. The GOP is no longer in a position to make cynical and opportunistic objections to the status quo; they will have full ownership of whatever new product they create. The outcome of the 2017 legislative process is very much up in the air.