Among the U.S. political developments I never would have predicted: the Republican-controlled Congress was unable to repeal the Affordable Care Act under a president ready to sign the bill into law. After canceling a planned floor vote today on the American Health Care Act, House Speaker Paul Ryan acknowledged, “Obamacare is the law of the land. … We’re going to be living with Obamacare for the foreseeable future.”

In the depths of my despair after the November election, I felt sure that the Affordable Care Act would be history by now, and Congress would be well on the way to privatizing Medicare.

Among the many reasons Republicans failed to draft a coherent health care alternative and could not coalesce around the half-baked American Health Care Act, the most important is this:

They made too many promises they couldn’t keep.

There’s no way to guarantee coverage for pre-existing conditions without requiring people to purchase insurance before they get sick. That’s why the conservative Heritage Foundation championed the individual mandate many years before anyone had heard of Barack Obama.

There’s no magic wand to “drive down costs” while providing better coverage for everyone. Changing the law to lower premiums for young, healthy people will raise costs substantially for sick or older people.

Government can’t “help people who need the help” and block insurance companies from imposing yearly or lifetime caps without regulating the market in ways much like the Affordable Care Act did.

David Frum lost his conservative think tank job after writing this blog post in March 2010.

Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s. […]

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

Today, Frum reflected on why Republicans were unable to follow through on their promises to repeal Obamacare, even after last November’s victories: “Too many people benefit from the law—and the Republican alternatives thus far offer too little to compensate for the loss of those benefits.”

When Obama was in office, House members like Representatives Rod Blum (IA-01) and David Young (IA-03) didn’t have to worry about the consequences of voting for Republican health care bills. This week, facing the prospect of President Donald Trump eventually signing the bill before them, Blum and Young were forced to confront reality. Their party’s plan would not “work for all Iowans” or be “affordable for every patient.” Platitudes about selling insurance across state lines and health savings accounts would not stop tens of millions Americans, including 150,000 to 250,000 Iowans, from losing their insurance coverage.

Representative Steve King (IA-04) came out early against the American Health Care Act but caved this week after the White House promised Senate Republicans would strip “essential health benefits” out of the bill. His grand gesture was for nothing. And what an odd demand to make: letting corporations go back to selling junk insurance to unsuspecting consumers. (As Josh Barro explained here, the unintended consequences of such a policy would be disastrous.)

President Donald Trump is already rewriting history to cover for his epic negotiating failure. But people will remember his many promises to repeal Obamacare quickly.

Several Iowa Republicans in Congress vowed today to keep working on health care reform. I enclose their statements below. Ryan doesn’t seem inclined to put his credibility on the line again anytime soon. Instead, he and Trump will move on to other legislation and hope the Affordable Care Act collapses on its own. Health and Human Services Secretary Tom Price will do what he can through administrative rules to chip away at Obamacare’s protections.

Nevertheless, today’s political victory should not be understated. Not only will millions of Americans keep their health insurance, Democrats will be better positioned for future battles over Medicare or Social Security. I’m grateful to every Iowan who contacted Blum or Young to tell their Affordable Care Act stories. Your efforts mattered.

Any relevant thoughts are welcome in this thread.

UPDATE: I wasn’t watching the NCAA basketball tournament Friday night, but a friend mentioned seeing a bizarre ad thanking David Young for helping repeal the Affordable Care Act. Timothy Burke has the story and the video at Deadspin. My transcript of the female voice-over:

“Republicans are keeping their promise with a new plan for better health care. More choices and lower costs. Putting doctors and patients in charge again. No more big government penalties or job-killing mandates. New tax credits to make insurance cheaper. And real protections for people with pre-existing Thank Congressman David Young for keeping his promise and replacing the Affordable Care Act with the better health care you deserve.”

The American Action Network PAC is a 501(c)(4) organization created in 2010 “by Norm Coleman, a former Republican senator from Minnesota, and Rob Collins, a former chief of staff to [then] House Minority Whip Eric Cantor.” A leading figure in the American Action Network, Fred Malek, was a founder of the Congressional Leadership Fund super-PAC in 2011.

Reid Epstein reported for the Wall Street Journal on March 23 that the “Congressional Leadership Fund is pulling staff from and closing an office it opened last month in Iowa” to support Young’s 2018 re-election campaign. According to the Open Secrets website, the super-PAC spent $1,843,418 in IA-03 during the 2016 election cycle, entirely on messages opposing Young’s Democratic challenger Jim Mowrer.

Jason Noble reported for the Des Moines Register,

An aide to Young said the congressman’s campaign was not aware of any aid being provided by the Congressional Leadership Fund nor any plans by the PAC to withdraw that support. But, he added, Young wouldn’t be swayed by any pressure from political leaders in Washington.

“David Young from day one has said that whoever the speaker is, the majority leader or president, they are not his bosses,” Young aide James Carstensen told The Des Moines Register on Thursday. “His bosses are the people of the 3rd District of Iowa.”

For now, Young is not among the ten House Republicans in the National Republican Congressional Committee’s “Patriot Program” for vulnerable incumbents. The NRCC spent $1,920,682 on Young’s race during the 2016 cycle.

Earlier this month, the NRCC released this statement when House leaders unveiled the GOP health care proposal.

“Republicans have consistently won on the promise of real healthcare reform and the American Health Care Act keeps those promises to the American people,” said NRCC Chairman Steve Stivers.

“Democrats have suffered significant losses in recent election cycles, yet they still refuse to listen to the demands of their constituents. Obamacare is failing and Republicans are determined to replace it – Democrats can either join us or feel the repercussions again in 2018.”

That sure didn’t hold up well.

SECOND UPDATE: Young spoke with the Des Moines Register’s Kathie Obradovich.

“I’m frustrated because we’ve seen it all before and we said we wouldn’t do it, and we did,” Young said in an interview Saturday.

It all started with a rushed timeline, which gave House members little time to read and comprehend the bill, let alone allow their constituents to discuss it. […]

Then, Young said, he started hearing about secret meetings and backroom deals that changed the bill.

Young was a staffer for Sen. Chuck Grassley when the Affordable Care Act was approved, so he had a front-row seat the last time around. Sure enough, GOP leadership made some of the same mistakes with their replacement bill.

“There were special deals in this bill for New York, for Illinois,” he said. “The rollout was bad, the messaging was bad,” he said.

How disingenuous. While crafting the health care reform bill in 2009, Democrats worked with Republicans including Grassley for months. They made lots of concessions to Republicans. There was no “rushed timeline”–the Affordable Care Act came to a vote in March 2010. Perhaps Grassley was negotiating in good faith for a while, then got scared by tea party activists at his August town-hall meetings. Or perhaps he was just stringing Democrats along from the beginning. Either way, the rise and fall of the AHCA over a three-week period was in no way comparable to Obamacare’s journey through Congress.

Young told Obradovich he wants Republicans to keep trying to replace the Affordable Care Act, but “take the time to do it in a transparent way and air it out and sell it to the American people and not be afraid of that.” He’s not grappling with the real problem: the talking points he’s been repeating for years don’t correspond to reality or lead toward his stated goal of affordable coverage for all.

March 24 press release from Representative Rod Blum:

Congressman Blum’s Statement on Pulling of AHCA

WASHINGTON, DC – “I support the President’s decision to pull the AHCA bill today. Throughout this process, I have been consistent in stating that the main goal of any reform bill must be to make healthcare more affordable for hardworking American families. Unfortunately, the AHCA fell short of that goal, and for that reason I could not support it. I believe Congress should slow down and discuss in an open and transparent manner the best solutions to address the real problem: the unsustainably high cost of healthcare in America. I will always do what I think is right for the citizens of Eastern Iowa, not what the political class in Washington wants me to do — even if that means standing up to my own party.”

March 24 press release from Representative David Young:

Congressman Young’s Statement on American Health Care Act Development

“Too many times in history we have seen leaders make avoidable mistakes. Too many Americans have been suffering under the mistake made seven years ago when Obamacare was rushed through Congress and to President Obama’s desk. It is a failed law that does not work for everyone and the problems and costs created by it are only going to get worse with each passing year.

Great leaders know when to pause a journey down a path that isn’t working and see the opportunity and optimism in starting over.

Bottom line – we need laws that work for all Americans and for all patients – not just some. It is a fundamental principle that repeal, reforms and fixes to our healthcare are done in the right way, for the right reasons, and in the right amount of time it takes to ensure we avoid the mistakes of seven years ago.

I applaud the President, House leadership and my Republican colleagues in taking the bold move to pause and begin anew with a thoughtful and deliberate process that takes the time and input to get this right to achieve accessible, affordable quality healthcare for every American.”

Representative Steve King’s March 24 speech on the House floor:

Tweet by King after cancellation of House vote: “Now then bring to the House floor HR 175, the FULL ObamaCare repeal. Rip it ALL out by the roots!”

Senator Chuck Grassley didn’t release a statement but posted several tweets on today’s news: “House withdrawal of Obamacare repeal will bring attention to Cassidy/Collins Senate bill The2 hv worked real hard to sell it to Reps&Dems”

Followed by: “Lessons learned fr Obamacare failure and House withdrawal of Obamacare repeal:::major social policy change in US must be bipartisan” (Then Senate Finance Committee Chair Max Baucus desperately wanted Grassley’s support for a bipartisan bill.)

And finally, “Failure of Obamacare repeal today will give increased attention to Cassidy/Collins approach to fixing the failure of Obamacare CHECK IT OUT”

Statement released by Senator Joni Ernst:

Along my 99 county tour, I have heard many stories from Iowans facing premium increases, as well as increases in deductibles and copays that they simply cannot afford, all as a result of ObamaCare. While the House did not advance a bill today, we all must continue to work together to promote affordable, patient-centered health care solutions that work for Iowans. As with any reform, we must ensure that it is done thoughtfully and carefully. Making sure Iowans have access to affordable coverage is, and will continue to be, my number one priority […]

UPDATE: Grassley’s office has been sending Iowans this form letter.

March 24, 2017
Dear [name]:

Thank you for taking the time to contact me. I’m glad to have the benefit of your views.
I appreciate hearing your thoughts about the American Health Care Act (AHCA), legislation proposed to replace the Affordable Care Act, or Obamacare.

A vote on the AHCA was scheduled for March 24th in the House of Representatives but the bill did not have enough votes to pass. It is unclear whether the bill will be brought up for consideration again in the House.

Simply put, the Affordable Care Act, enacted in 2010, has been a case of over-promise and under-delivery. People were told their premiums would go down, and that if they liked their doctor, hospital or health care plan, they could keep all of it. The reality has been much different. More than half of the country will have two or fewer insurance plans to choose from on exchanges in 2017. Some regions may have no insurance plans available. Even those who were strong supporters of the health care law, like the Minnesota governor, have said that Obamacare “is no longer affordable to many Americans.” In Iowa, premium increases for participants will be 19 percent to 43 percent and many individuals have deductibles and copays so high that it makes their insurance too expensive to use.

The current, ongoing debate on healthcare reform is an opportunity to have robust discussion about how to deliver quality, affordable healthcare to all Americans. It gives Congress the opportunity to address the reasons that 28 million Americans still have no coverage under Obamacare and it forces an important debate about why healthcare costs so much. I believe healthcare reform should rest on a few principles.

First, no one should be disqualified from getting insurance for having a pre-existing condition and there should be no annual or lifetime limits or medical underwriting. If you have children under the age of 26, they should be allowed to stay on your insurance.

Second, any healthcare reform plan has to address the rising cost of healthcare. There is nothing in place to address the underlying causes of the high cost of health care – that is, what it costs for a hospital or doctor to purchase and maintain medical equipment, purchase medicines, carry malpractice insurance, and the like. Lowering the costs of things like those I just listed would drive down the cost of health care, emergency room visits, and health insurance premiums.

Third, healthcare reform has to reestablish states as the main regulators of healthcare. All states have different demographics and healthcare needs and reform must begin with the idea that states know what’s best for their constituents.

I believe these are the principles that Congress needs to follow as we reform our healthcare system. The American people deserve a long-term solution that gives them more choice for less cost, and empowers individuals and states to make their own healthcare decisions.

Thank you again for contacting me. Please keep in touch.
Sincerely,
Chuck Grassley