GOP may not be punished if it can't pass repeal

The GOP base will punish Republicans in upcoming elections if they fail to deliver on their promise to repeal the Affordable Care Act, or at least make an all -out effort to do so. That's the conventional wisdom, right? It was the political motivation behind Republican efforts to pass a widely unpopular repeal-and-replace plan, and then to consider a risky repeal-and-delay plan in the Senate.

Except for one problem: When you look at the polling, the idea that the base will rise up and punish Republicans if they don't repeal the ACA appears to be exaggerated, and possibly even a political fiction.

Data: Kaiser Family Foundation Health Tracking Poll (Nov. 15-21, 2016); Chart: Andrew Witherspoon / Axios


  • As the chart shows, health care was not the top concern for Trump voters and Republican voters in the 2016 presidential election. It ranked far behind their general concerns about the direction the country is headed in, jobs and the economy, and their feelings about Hillary Clinton. Just 7% of Trump voters and a paltry 5% of Republican voters picked health care as the biggest factor in their vote.
  • Focus groups with Trump voters reinforce this picture; they are focused much more on making ends meet and, when health comes up, getting help with paying their premiums and deductibles. They hoped candidate Trump would find a way to help them pay their health care bills. Just like Democratic voters, and all voters, they care more about their health care costs than the partisan Washington debate about the ACA.
  • Republicans also don't show high levels of intensity on the issue. For example, in July, just 25% of Republicans said they had a "very favorable" view of the Republican ACA replacement plans, while 52% of Democrats said that about the ACA.
  • About half (52%) of Republicans have supported the idea of repealing the ACA now and replacing it later, but that is hardly an overwhelming mandate. (Just 26% of the public overall supported the idea.) Still, most Republicans do want to keep trying. In July, 80% said they don't want to give up on efforts to repeal and replace the ACA.
  • The most conservative Republicans who advocate repeal come from safe districts. They have little to worry about, whether the ACA is repealed or not.

Republicans don't like the ACA, and there is no doubt voting for repeal would be a real plus with the Republican base as well as with big campaign contributors. But the assumption that Republicans will be punished if they fail to repeal the law is a different thing altogether; it has become unexamined conventional wisdom. Republican voters have other things on their minds that matter to them more than health care.

The next election is not until 2018, and the agenda could switch to taxes or a foreign conflict or the Trump administration's continuing problems. In fact, the one thing most likely to keep the ACA on the agenda now would be an effort by the administration to undermine it, and it's far from clear who benefits and loses politically from that.

Jonathan Swan 13 hours ago
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Trump's two-front war

Photo: Jabin Botsford / The Washington Post via Getty Images

President Trump is ending the week with a flop — nowhere close to the border wall funding he wanted in the DACA-less spending bill that congressional leaders released last evening. But he's fulfilling one of his most aggressive campaign promises with his anti-China trade action.

The big picture: Trump's expected announcement today of tariffs on Chinese imports is a big deal, and analysts fear it could provoke a trade war — and it comes as Trump has been battling his own party here at home over the government spending bill.

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The worst flu season in eight years

Note: Activity levels are based on outpatient visits in a state compared to the average number of visits that occur during weeks with little or no flu virus circulation; Data: Centers for Disease Control and Prevention; Chart: Chris Canipe/Axios

This year's flu season caught many experts off guard with both its sustained prevalence and its virulence. At its peak, there was a higher level of flu-like illnesses reported than any other year during the past eight years. Watch in the visual as it hits its peak around Week 18.

Why it matters: Public health officials try to capture this data when developing the next year's vaccines. And, of course, they want to find better ways to prevent severe flu seasons. There's a "Strategic Plan" to develop a universal vaccine to protect against a wider range of influenza viruses, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, tells Axios.