There are two fundamental paradoxes that created political problems for the Affordable Care Act. The first is that while as a whole the American health care system as a whole is horribly inefficient and inequitable, large numbers of politically important people (most notably, people with Medicare and good employer-provided insurance) are personally happy with the status quo. The second is that the individual components of the ACA were mostly very popular even though the law itself was not.
Republican efforts to repeal the ACA have, however, completely transformed the debate:
As President Donald Trump and the Republicans in Congress gear up for another attempt at repealing and replacing Obamacare, an ABC News/Washington Post poll finds broad public preference for keeping and improving it — including high levels of support for some of its key components.
Just 37 percent of Americans in the national survey say Obamacare should be repealed and replaced; 61 percent say it should be kept and fixed instead. Even more broadly, the public by 79-13 percent says Trump should seek to make the current law work as well as possible, not to make it fail as soon as possible, a strategy he’s suggested.
Both the status quo bias that makes any major change to health care laws enormously difficult and the popularity of the ACA’s components are now working in the law’s favor, and will make the specific Republican proposals even less popular than repeal in the abstract. I would make an Overton Window joke only the Republicans didn’t. even. try. to sell their real alternative (health care rationed by the glories of the Free Market) because it’s massively unpopular, and cynically attacked the ACA from the left instead. With a Republican in the White House the shell game doesn’t work.