Way back on December 3, 1993, early in the Clinton Administration, conservative political strategist William Kristol distributed a memo urging the GOP to go all out to block health insurance reform because it would likely prove so popular as to be, in his words, “a serious political threat to the Republican Party.”
Its passage in the short run will do nothing to hurt (and everything to help) Democratic electoral prospects in 1996. But the long-term political effects of a successful Clinton health care bill will be even worse—much worse. It will relegitimize middle-class dependence for “security” on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
Fifteen years later, Obama’s election provoked the same alarm. In a November 21, 2008, article for U.S. News, James Pethokoukis of the American Enterprise Institute declared that healthcare reform could “kill conservatism.” He reported that even before the election a “scary serious” GOP strategist had said to him, “Let me tell you something, if Democrats take the White House and pass a big-government healthcare plan, that’s it. Game over.”
Indeed, just a week earlier Michael Cannon of the Cato Institute had published an article whose title summed up the fear succinctly: “Blocking Obama’s Health Plan Is Key to GOP’s Survival.”
In a November 1 interview the following year, Senator Orrin Hatch (R-Utah) warned the pro-Republican Cybercast News Service that if healthcare reform proved successful, “you’re going to have a very rough time having a two-party system in this country, because almost everybody’s going to say, ‘All we ever were, all we ever are, all we ever hope to be depends on the Democratic Party.’”
I don’t mean to suggest that rank-and-file Republicans think this cynically, and to be sure, a lot of Republicans seem to believe in all sincerity that the ACA is harmful, despite the fact that the ACA is actually based on conservative proposals, despite the surveys that show substantial Republican support for almost all ACA provisions taken individually, despite the hard evidence that the ACA has been a lot more beneficial than harmful, and despite the now-obvious nonexistence of the supposed "death panels" and other silly horrors promised by the nuttier opponents.
But clearly, some influential Republican leaders have been worrying that the better the Affordable Care Act works the more it hurts them politically. This explains why improvements are being fought tooth and nail.