Health care’s secret negotiations were a major factor in their failure

There are two primary reasons why the Republican effort to repeal and replace ObamaCare failed that have been overlooked: a failure to lay the groundwork with the public, and "secret negotiations" that inhibited the ability of Republicans to continually highlight the failures of the ACA at a crucial time when the public was focused on the issue.

A failure to lay the groundwork: Republicans had seven years to produce an alternative plan but chose not to do so.

Republicans have promised that they would repeal and replace ObamaCare once they had the votes to do so.

However, instead of producing a detailed replacement plan that allowed public digestion and discussion of its pros and cons, Republicans felt that was too risky.


They were concerned that putting out a detailed plan would give opponents a continuous opportunity to attack it. Instead, they waited until the time to put a bill together was at hand, and tried to muscle a proposal through a narrow Senate majority.

Compare that approach to what Republicans have done on tax reform: while full details have yet to be announced, the general parameters of the tax reform plan have generally been publicly discussed for years, and Republicans are actively talking about the need to reform the tax code and what those reforms may look like.

There has, for example, been an active debate about how the package will be paid for — including a very contentious and public debate over the BAT. This debate has not been held behind closed doors, but has been fully transparent.

While some Republicans may not be happy that one of the results of this public discussion is the jettisoning of the BAT, it also helps ensure that a large sector of the economy won’t raise serious concerns and potentially oppose the bill at the end of the day.

Had Republicans led a constructive, public debate about the failures of the Affordable Care Act and what they intended to do to fix it, some ideas might have been scuttled, but the larger package likely would have survived.

Secret negotiations hindered the ability to continually highlight ACA shortcomings, ceding the field to ACA supporters.

Throughout the meat of the health care debate, when the press and public were intently focused on the issue, Republicans ignored the public discussion, and instead focused on extensive behind-closed-doors negotiations. That failure to continually “beat the drum” about the failures off the ACA ceded the field to supporters of the ACA and helped kill the legislation.

For example, while Republicans were busy negotiating, ACA supporters drove the public narrative and set the terms of the debate and defined the policies that Republicans were considering without any rebuttal or other real engagement from Republicans.

For instance, since the enactment of the ACA, Republicans have been continually highlighting the shortcomings of the Exchanges and significant premium increases of the ACA.

However, during these Hill discussions, the only ones talking about the ACA were supporters who highlighted the extension of protections for preexisting conditions. When the bill finally came up for a vote, the only thing the press covered was the effect that the Republican bill would have on preexisting conditions protections.

This impact can clearly be seen in polling results, which showed, for the first time, that the ACA was gaining popularity. Again, not because the policies changed, but because only supporters of the ACA were talking about it.

Lesson learned: public debate is a vital component of public policy success.

Companies that sell consumer products from cars to candy understand the importance of continually marketing their products to consumers, making sure that consumers are continually aware of their brand.

Marketers also understand that if consumers are not thinking about their product, they are likely to choose an alternative, perhaps picking up a bag of chips for a snack instead of a candy bar, and each company is constantly striving to make their product top-of-mind for consumers.

During campaign season, politicians understand that as well, as they blanket the airwaves with messages about why voters should choose them over their opponent, knowing that if they don’t define themselves, their opponents will.

Public policy is no different, particularly for issues that the press covers frequently and that most consumers think about on a regular basis, such as health care and taxes. Engagement enables policy professional to define the terms of the debate, explain what the problems are, and describe why their proposed solution would solve those problems.

Once they get a Congressional majority in Washington, however, politicians often fail to incorporate the lessons learned on the campaign trail about the need for continual communication necessary to influence public opinion, and instead believe that simply muscling a solution through on a party-line vote will work.

The failure to use basic public relations tools to continually discuss the reasoning behind certain policy choices on health care has been a key factor in why it failed. Hopefully policy advocates will take that lesson to heart in future debates.

Joe Rubin is Senior Vice President of MWWPR. The views expressed here are solely his own, and do not reflect the views of MWWPR or any clients.