Trump’s presidency fuels conservatism’s decline

The most significant development in the health care exercise occurred when Republican leaders determined that it was politically untenable to go back to a system in which people could be denied health insurance because of a preexisting condition. That, in itself, was a major concession. Obamacare’s complicated bureaucracy of taxes, mandates, and subsidies were all designed to ensure that insurance companies could make a profit while covering sicker patients. From this point on, Republicans were conceding that health insurance is a right that government must provide—a point that Republicans fought aggressively during the original Obamacare debate.

There are plenty of credible arguments that Republicans could advance to make the case for an Obamacare rollback. They could argue that public spending on health care crowds out necessary resources for other priorities, notably infrastructure, education, and tax cuts. They could point to studies showing that expanding Medicaid consigns its recipients to narrow networks of doctors and poor health outcomes. They could have made an economic argument that the law’s arbitrary mandate requiring businesses with over 50 employees to offer health insurance stunts growth. But few advocates of the Republican approach tried to make a free-market case for rolling back Obamacare, instead insisting that more people would be covered as a result of the GOP’s reforms.