President Donald Trump said last week that “nobody knew that health care could be so complicated.”
But the aides and advisers who worked on health care for Bill Clinton and Barack Obama — they knew.
“Maybe I should just say karma is a serious thing,” said Neera Tanden, who was a top health official in the Obama administration. “Health care is hard. Governing is hard. And Republicans are now living with the fruits of never putting forward a plan and making promises they can't keep.”
It’s a strange place to be for the Democratic operatives and elected officials who saw their party devastated in part by Obamacare. And some can’t help but feel a bit of cosmic justice as they watch Republicans, who passed their plan Friday in the House Ways and Means Committee, stuck in a policy quagmire they know all too well.
Jonathan Gruber, an MIT economist who helped design the Affordable Care Act, said health care policy is both extremely complicated and extraordinarily personal.
"It's healthcare, it should be easy. Everyone goes to the doctor. But it's super hard," Gruber said. “As a result, it’s easy to demonize everything.”
He added, "They (Republicans) have spent years trying to demonize Obamacare and say there was something better, but there was nothing better ... It's overall a sad story. I don't think anybody can feel good about this."
Clinton strategist James Carville, a veteran of both recent Democratic reform efforts, has a maxim that “the mover on health care loses,” as he told Democratic donors at a January retreat in Florida. “To do something is to lose.”
After years of unpopularity, nearly six-in-10 Americans now say they want to keep Obamacare or make only minor fixes to it. Fewer than four-in-10 call for repealing it or replacing, according to a new Monmouth Poll.
Republicans "now own the American health care system, which is something that they very effectively said that we owned for seven years,” said Ben Wakana, a former spokesperson for Obama’s Department of Health and Human Services.
"As you see this circular firing squad, part of the problem is they don't have any principles on health care," he added. "The thing that kept us grounded when things got hard was we had principles. That kept us all on the same team and in the same room."
“If you look at the big debates about health care starting with Truman, going to Nixon, going to Clinton, going to now, you find that on the surface, the issues look really straightforward because everybody agrees health care is a big mess. But then you peel it open and it’s unbelievably complex,” said Robert Blendon, a Harvard professor who studies the politics of health care. “It starts to break apart the minute you get into the details.”
That’s exactly what happened after House Republicans rolled out their draft bill to repeal and replace Obamacare Monday night. The response swift and largely negative, leaving a plan seven-years-in-the-making in critical condition less than 24 hours after its public debut.
"The Republicans have done what Democrats couldn't: Brought the popularity of Obamacare to record levels. They made every election a referendum on Obamacare,” said former Rep. Steve Israel, a Democrat.
Israel led House Democrats’ election efforts during the brutal 2010 midterm, when Republicans rode an anti-Obama backlash to gain 63 seats. Now Israel anticipates Democrats will run on, instead of away from, health care.
“You can expect House Democrats to make the midterm election on ‘Ryancare,” he said.
Democrats have already started collecting sympathetic stories from people who credit the ACA with saving their lives.
And the party’s campaign arms are zeroing in on a handful of provisions in the proposed draft they think are politically toxic: Funding cuts to efforts to fight the opioid epidemic, penalties for Planned Parenthood, and a tax break for insurance company CEOs who make more than $500,000 a year.
The 2018 midterm elections are still a ways off, but Democrats say they intend to put repeal front and center.
“GOP Senate candidates will now have to defend an agenda that protects the wealthy and well-connected at the expense of Americans who actually work for a living,” said Maryland Sen. Chris Van Hollen, who chairs the Democratic Senatorial Campaign Committee. “Regardless of whether it gets a vote, we’ll make sure there is no rock Republican Senate candidates can hide under.”