NEJM August 9, 2017
For 7 years, Republicans vowed to repeal and replace the Affordable Care Act (ACA). With Donald Trump in the White House and Republican majorities in Congress, the GOP was poised to make good on that pledge. Yet less than 7 months into the Trump administration, the GOP’s crusade to dismantle Obamacare has, at least for now, collapsed.
Republicans have been bedeviled by internal party divisions, strategic miscalculations, the absence of a viable replacement plan, the resilience of the status quo, and the constraints of American political institutions. Given their slim 52–48 majority, passing health care legislation in the Senate required forging a near-consensus among GOP lawmakers. Conservative and centrist Republicans could not, however, agree on whether the party’s repeal proposals...
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