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House Speaker Paul Ryan during the 2017 health care debate. (Photo:Win McNamee/Getty Images)

The past decade's health care wars have pushed Republicans to the right, squeezing out moderates who see some acceptable role for the federal government.

Why it matters: More health care wars are coming, and the parties are only moving further away from each other. By demonizing so many policy ideas as "Obamacare-lite," the GOP has left itself with fewer policy alternatives and less room to compromise.

“The far right has kind of sucked all the oxygen out of the room. Right now, it does seem like it’s hard for more moderate policy ideas to really get a lot of traction."
— Ben Ippolito of the American Enterprise Institute

The big picture: The Affordable Care Act "changed radically the nature of the way Republicans view health care," said Rodney Whitlock, a lobbyist and former aide to Sen. Chuck Grassley.

Before the ACA, there were plenty of conservative arguments for a stronger federal role in the health care system. Many of those more moderate GOP ideas made it into the ACA, mixed in with other traditionally Democratic policies.

  • "The infrastructure of the Affordable Care Act was a hell of a lot closer to Romneycare than a single payer system," Whitlock said.

Now that the party has bitterly opposed the ACA for nearly a decade, it's difficult to propose ideas that bear any resemblance to it.

  • “After watching 2017 unfold and the occasions of which 'Obamacare-lite' got thrown out at some folks, for Republicans, it’s going to be hard for them to look at anything other than basically ... confederal solutions, where they say its important that we send solutions out to the states, and we step back," Whitlock said.

“It’s hard enough to make policy as it is. It’s nearly impossible if you don’t give yourself any options," Ippolito told me. "They are giving themselves an awful lot of constraints to deal with.”

  • "If you're not even willing to concede that some version of regulated competition is a plausible strategy for this market, then realistically, what are you going to argue down the road?" Ippolito asked. "We’re going to take the stand of [Sen.] Rand Paul? His idea of health care is the only one we’re allowed to have now?"

Last year's repeal-and-replace effort also reinforced the popularity of several ACA regulations, like requiring insurers to cover pre-existing conditions. Yet those rules are a target for the right flank of the party, because they increase premiums.

What's next: The health care system's problems are not solving themselves. And while Democrats solidify their response — some form of expanded government coverage — many elected Republicans are trying to avoid the topic.

  • Off the Hill, there are plenty of center-right policy wonks cranking out ideas, like increasing price transparency to foster market competition and automatically enrolling people in private health insurance.
  • But if moderates in both parties are losing power, "the chances of serious bipartisan discussions on health care are basically nil," Kaiser's Larry Levitt told me.

"Obamacare left such a sour taste in our mouth," Sen. Mike Rounds told me. "So anything that looks like that, immediately people are suspect," he continued. "On the other side, there’s a lot of us that really do believe that if you allow for competition on the marketplace and you allow for innovation, and you make it a fair playing field, you could come up with some really good health care policy."

Go deeper

Complaint to FTC: Amazon search results full of potentially deceiving ads

Photo: Nigel Kirby/Loop Images/Universal Images Group via Getty Images

Amazon does not sufficiently distinguish between its search results and paid ads, potentially "deceiving millions of consumers," according to a complaint filed to the Federal Trade Commission.

Why it matters: Joan Moriarty, research director for the Strategic Organizing Center, a coalition of labor unions that filed the complaint, told the Washington Post the group is "very hopeful" that the FTC will investigate the complaint because Lina Khan (D), a known Amazon critic, is now chair.

4 hours ago - Health

Pfizer-BioNTech: Booster doses more effective at blocking Omicron

Prepared doses of the BioNtech-Pfizer Covid-19 coronavirus vaccine in Germany on Dec. 7. Photo: Thomas Kienzle/AFP via Getty Images

Pfizer and BioNTech said Wednesday that two doses of their COVID-19 vaccine were significantly less effective at neutralizing the Omicron variant in early lab tests, but a three-dose regimen was more effective.

Why it matters: Omicron, which has been labeled a variant of concern by the World Health Organization after being identified by scientists in South Africa last month, has forced vaccine makers to reassess the effectiveness of their vaccines against this specific new form of coronavirus.

Mike Allen, author of AM
4 hours ago - Politics & Policy

Biden unveils "Building a Better America" branding

President Biden speaks on infrastructure while visiting a bridge in Woodstock, N.H., last month. Photo: John Tully/Getty Images

President Biden today launched a new website and unveiled bold new branding as part of a nationwide tour to sell the benefits of his infrastructure package.

Why it matters: The White House says passage of the new law shows the ability to "forge bipartisan consensus and prove our democracy can deliver big wins" even in these toxic times.