Legislation can be crafted bottom up or top down. In bottom up you ask, What problems do voters have and how can they be addressed. In top down, you ask, What problems do elite politicians have and how can they be addressed?
The House Republican health care bill is a pure top-down document. It was not molded to the actual health care needs of regular voters. It does not have support from actual American voters or much interest in those voters. It was written by elites to serve the needs of elites. Donald Trump vowed to drain the swamp, but this bill is pure swamp.
.. There was no core health care priority that Republicans identified and were trying to solve.
.. There were just some politicians who wanted a press release called Repeal.
.. They could have drafted a bill that addressed the perverse fee-for-service incentives that drive up health costs, or a bill that began to phase out our silly employment-based system, or one that increased health security for the working and middle class.
.. They were more concerned with bending, distorting and folding the bill to meet the Byrd rule, an arbitrary congressional peculiarity of no real purpose to the outside world. They were more concerned with what this internal faction, or that internal faction, might want.
.. It would boost the after-tax income for those making more than $1 million a year by 14 percent
.. this bill the Republican leadership sets an all-time new land speed record for forgetting where you came from.
Why couldn’t Republicans who voted to repeal Obamacare so many times under Obama do it under a Republican president?
@tim has given a good answer in terms of the specific vote. However it’s also worth looking at the reason why the Republicans couldn’t get behind a replacement.
The problem that the Republicans face is that the key elements of Obamacare were actually Republican ideas. This paper from the Heritage Foundation outlines the main points which were later introduced into Obamacare. When Mitt Romney was Governor of Massachusetts he introduced a statewide health law based on these same ideas. (Edit: added link to list of similarities and differences)
When President Obama proposed the Affordable Care Act the Republican party was faced with a difficult choice. They could have supported the ACA while pointing out that Obama had merely pinched their best ideas, but this would have meant handing Obama a major political victory and an important historical legacy. Since they hated Obama they couldn’t stomach that, so instead they decided to airbrush out their own history and position themselves in opposition. They managed to make hatred of Obamacare a major mobilising point for their base, but now they have the opportunity to replace Obamacare they are in a bind: they can’t create the scheme they had planned because it would be too obviously Obamacare with a red paint job, but they don’t have any new ideas to replace it.
Trump isn’t helping. He promised to replace the “broken” and “unconstitutional” Obamacare, but never got around to saying what he would replace it with. Then he discovered (to his immense surprise) that it’s complicated.
Lo & Behold: A Replica Of The Successful 2015 Obamacare Repeal Is Languishing In Committee
After the AHCA debacle that may seem unlikely, but consider the fact that this bill already passed in the last Congress. Repeal is the one thing a majority ostensibly agree upon.
.. “Conservatives expect nothing less than congressional Republicans to live up to their promises,” Jason Pye of FreedomWorks told RedState. “They passed this bill in the 114th Congress. Why can’t they do it now? This is the one aspect of this we all agree on, and it’s certainly a better option than the half-baked bill that leadership rolled out that didn’t really repeal ObamaCare.”
.. A clean repeal is what Republicans have been promising the American people for seven years. A clean repeal bill is sitting in committee, ready to go through the same process it breezed through in 2015 but in which the AHCA failed. As has been said before here, should Republicans fail to adequately reduce the cost of health care and increase access by repealing — and replacing to a degree — Obamacare, they will be seen as the biggest scammers in American politics for a generation.
The 2015 repeal bill is there, let’s pass it.
Pence says Trump will keep promise of overhauling Affordable Care Act
Vice President Pence said that President Trump intends to keep his promise to overhaul the Affordable Care Act, pledging that the legislation’s collapse Friday was a setback that “won’t last very long.”
“President Trump is never going to stop fighting to keep his promises to the American people,” Pence said
.. “But as we all learned yesterday, Congress just wasn’t ready,” Pence said.
.. Pence pointed to a Saturday morning tweet from Trump suggesting Democrats would be forced to work with Republicans on a replacement bill once the Affordable Care Act “explodes.”