Will Republicans Actually Face Consequences From Their Base for Failing to Repeal the ACA?

With each new Republican attempt to repeal the Affordable Care Act again crashing of the rocks of political reality, we get treated to Republicans warning of dire electoral consequences from failing to act on their biggest campaign promise. Case in point:

President Donald Trump warned House Republicans Tuesday if they can’t pass health care legislation after seven years of promises it could be a “bloodbath” in the 2018 midterm election, according to one member present in the meeting.

But is this actually true? Will Republicans face dramatically reduced turnout from their base if they fail to repeal it? I’m not so sure.

It’s important to remember that base conservative anger at the ACA is an entirely manufactured phenomenon, without even an objective correlative or specific dogwhistle in play. Most conservative betes noires work on the base because they relate to some very specific anger or prejudiced fear: their kids will be rejected from college because affirmative action gave their spot to a minority; they have to pay their cell phone bill but some poor minority will get a free “Obamaphone”; some Syrian person with a dangerous-sounding Muslim name will come in as a refugee and blow up their local WalMart; etc. These are the ugliest, least informed motivations in politics. They are deplorable. But they at least have grounding in fear of an actual consequence that will affect their lives.

The Affordable Care Act is different. Yes, there is the generalized fear that their insurance premiums will rise so that “others” can get less expensive healthcare. But the conservative base inclined to believe this either 1) is already on Medicaid or ACA plans, or 2) has enough life experience with healthcare to be aware of how much premiums were rising before the ACA passed. True, in 2010 conservatives swept to office by lying to Medicare recipients that they would be subject to death panels and that they their Medicare money would be given to “unworthy” poor people. But it’s 2017 now, and those lies have subsided through experience.

Meanwhile, the promised “death spiral” of Obamacare is also a myth: the exchanges seem to be in fairly decent shape overall, and the insurance market isn’t going to implode on its own.

So will conservatives really stay home in November if the ACA stays in place? Or will a polarized electorate mostly forget about the whole thing if Republican politicians give them some other shiny object to fret about?

I’m inclined to suggest the latter. The only real electoral danger to Republicans from a failure to repeal the ACA will come from opportunistic conservative primary challengers who will promise to repeal the ACA where their own legislators failed. But even that is a largely illusory threat, because most Republicans in the House did vote to repeal the ACA, and the Freedom Caucus members who refused are essentially immune to challenges from their right.

At this point the best move for Republicans is to do nothing. The polarization of the electorate, combined with the lack of clear cultural consequences for conservative white nationalists from a failure to repeal the ACA, suggests that the GOP won’t really pay a price for failing to deliver on their campaign promises.

David Atkins

David Atkins is a writer, activist and research professional living in Santa Barbara. He is a contributor to the Washington Monthly's Political Animal and president of The Pollux Group, a qualitative research firm.