In crowded town halls around the country, congressional Republicans last week faced Americans who voiced fear and anger over the prospect that they will lose their health insurance if the Affordable Care Act is repealed.
The lawmakers struggled to answer questions about what they will offer as a replacement. Some of lawmakers who chose to attend the town hall meetings seemed to backtrack on plans to completely repeal and replace the healthcare law, while others dismissed the protests as partisan whining from Democrats who haven't gotten over losing the 2016 presidential election.
But what's clear, said both Republican and Democratic observers, is that President Donald Trump and Republicans need to quickly coalesce around a solid ACA replacement plan they can sell to the public.
“The longer you go without actually detailing the replacement, the more this just looks like a repeal,” said Greg Jenkins, founder of North Bay Strategies, a strategic communication firm and press advance director for President George W. Bush's 2000 campaign.
More than 30 congressional Republican town hall meetings were held in the past week, according to the Town Hall Project site, which tracks public appearances by lawmakers.
Many of the events featured testy exchanges, tartly worded protest signs, tears, and pleas to preserve the ACA's coverage expansions, under which more than 20 million uninsured people got insurance. When asked to describe what they would substitute for Obamacare, some lawmakers admitted they didn't have anything concrete to offer yet.
“The wild card is how members react to the town halls,” said Chris Condeluci, a health policy consultant who served as a Senate Republican aide during the ACA's passage. “If the members come back freaked out, (repeal plans) could get pushed past the Easter break.”
Beyond the town halls, GOP lawmakers were faced with new polls showing dimming support for repeal, particularly without a good replacement. But many Republicans appear to be ready next week with their plans to repeal most of the ACA through expedited budget reconciliation legislation that can be passed on a straight party-line vote. A major factor will be how the nonpartisan Congressional Budget Office scores the bill for its impact on uninsured rates and budget costs.
Another reason to think the GOP won't back off is that their legislative timetable requires repealing the ACA before they can move on to their high-priority goal of cutting taxes for businesses and the wealthy, said Dave Dulio, a political science professor at Oakland University in Michigan.
Matthew Cox, a Republican and owner of the public relations firm Capitol Partners, said the GOP has focused too much on the ACA's unpopular individual mandate, rising premiums and limited plan options, and not enough on how people with pre-existing medical conditions will continue to be insured.
There were many emotional stories at town halls on the issue, which hits home for Cox. “For families like mine with a disabled child … we need to be able to plan for what's coming,” he said.
Some experts warn Republicans not to ignore the sentiments they heard at the town halls, or they may face the same political slaughter Democrats did in the 2010 elections after passage of the ACA, Dulio said.
Former Democratic Rep. Henry Waxman, chairman of Waxman Strategies and a key author of the ACA, said the fallout could be even worse for Republicans in 2018. At the time of the 2010 elections, “the ACA was only a theory of how to get more people covered, which was distorted by the propaganda of its opponents,” he said. “Now, it's a reality for millions of people, who do not want their insurance taken away.”