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.
- 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 They have little to worry about, whether the ACA is repealed or not.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.