Why ObamaCare survived

“Obviously, it is the case that there were not enough conversations about ‘replace,’” Brian Blase, a conservative health-policy expert who was a top domestic-policy adviser in the Trump White House, told me. Dean Rosen, a GOP leadership aide from the early 2000s who went on to become one of Washington’s most influential health-care strategists, said, “There was an intellectual simplicity or an intellectual laziness that for Republicans in health care passed for policy development. That bit us in the ass when it came to repeal and replace.”

One reason for this laziness was a simple lack of interest. For decades, Republicans had seemed interested in health-care policy only when responding to Democratic policies required it. “Republicans do taxes and national security,” Brendan Buck, a former GOP leadership aide, quipped in an interview. “They don’t do health care.”

That ambivalence extended to the GOP’s networks of advisers and advocates. The cadre of Republican intellectuals who worked on health policy would frequently observe that they had very little company, talking about a “wonk gap” with their more liberal counterparts. “There are about 30 times more people on the left that do health policy than on the right,” Blase said.

Another problem was a recognition that forging a GOP consensus on replacement would have been difficult because of internal divisions.