So near and yet, so far… That's the dilemma the Republican Party has found itself in over the last two years when it has attempted to undo the Affordable Care Act. The party gets achingly close to repeal part or all of Obamacare, only to fall just short of the required votes.

And unless midterm elections produce unexpectedly pro-GOP results, the repeal quest will likely remain the party's Holy Grail, glimmering in a future that never arrives.

Repealing the act has quickly taken a back seat as most Republicans are focused on maintaining their slim House majority. The party has so thoroughly botched health care reform that many have distanced themselves from it in hopes it won't taint their re-election campaigns.

The thorniest issue for Republicans to address is that of parity of coverage for those with pre-existing conditions. Popular support for that protection is so strong that, unless the GOP can produce a stand-alone replacement for that element of the act, key Republicans understand that they dare not repeal the act as it now stands.

Key Republicans Mitch McConnell, the Senate majority leader, and his No. 2, John Cornyn, have both gone decisively on the record as opposed to bringing up repeal prior to the mid-terms. A post-election repeal attempt would be undertaken only if the GOP does well in House and Senate elections, and only if it finds a solution to terminating pre-existing condition coverage.

The irony is that health care reform has become a threat to those running in November under the GOP banner. President Donald Trump's campaign promise to demolish Obamacare has proceeded so poorly that Democrats are pointing to the failure as emblematic of Trump's less-than-well-conceived campaign proposals.

But even as Republicans distance themselves from Obamacare repeal, a federal lawsuit brought by 20 states threatens to keep the repeal effort alive—and remind voters of the downsides of repeal.

The blue-state constitutional challenge to the ACA rests on last year's repeal of the act's requirement that all individuals either purchase insurance or pay a fine. Because the mandate was a critical piece of the act, the states argue, its elimination means the entire act should be abolished.

The states' true target appears to be to unburden insurers of covering pre-existing conditions among the insured, one of the basic tenets of the act. As the challenges make their way through the court system, surveys demonstrating strong bipartisan support for pre-existing coverage have emerged.

A recent Kaiser Family Foundation survey reported that 72 percent of those surveyed said affordable coverage for those with pre-existing medical conditions was “very important” to them. A more recent poll by Morning Consult/Politico registered an even higher level of support: 83 percent of Democrats, and 80 percent of Republicans, said they didn't think insurers should be able to deny coverage due to pre-existing conditions.

Such resounding support for pre-existing coverage hasn't been lost on Republicans; 10 of them introduced a Senate bill that would prohibit insurers from charging more for, or simply not offering, insurance to those with pre-existing conditions.

“… The one thing we can all agree on is that we should protect health care for Americans with pre-existing conditions and ensure they have access to good coverage,” said U.S. Sen. Thom Tillis of North Carolina in a statement. Tillis, who introduced the bill, added: “This legislation is a common-sense solution that guarantees Americans with pre-existing conditions will have health care coverage, regardless of how our judicial system rules on the future of Obamacare.”

Democrats and healthcare experts have pointed out that the bill doesn't offer full protection to those with pre-existing conditions. The issue has become a rallying cry for Democrats involved in mid-term elections. They continue to attack GOP candidates who either support, or are silent on, the loss of parity coverage that would accompany repeal of the act.

To make matters worse for the GOP, the pre-existing conditions controversy has become a hot button in the pending Senate vote on whether U.S. Court of Appeals judge Brett Kavanaugh should become the newest U.S. Supreme Court member.

Kavanaugh has consistently said Obamacare is unconstitutional. Last week, Hillary Clinton posted a defense of pre-existing conditions on her Facebook page, packaged as an attack on Kavanaugh. Her nearly 10 million followers read, in part:

“Do you have a pre-existing condition? Do you care about someone who has one? Could you or someone you love ever get one? Then you should call your senators today to #StopKavanaugh from getting a lifetime seat on the Supreme Court. Challenges to the Affordable Care Act's protections for patients, including the notion that insurance companies can't refuse to insure you if you have a pre-existing condition, are already working their way through the lower courts. The next Supreme Court justice will have a chance to rule on the fate of the Affordable Care Act, which helps millions of people get affordable health care. Brett Kavanaugh's record shows he'd be a threat to the law.”

So, far from dismantling Obamacare with grace and ease, Trump and the GOP have managed to turn the issue into a gigantic party liability. It's gone so far wrong that, even if the states' challenge succeeds, it is sure to tarnish the GOP in the eyes of millions of voting Americans.

Instant Insights /

GOP candidates sprinting away from ACA repeal

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