Republicans are fretting over their failure to repeal Obamacare. President Donald Trump claimed Senators who voted against its replacement, the American Health Care Act (AHCA) had “let down Americans.”
The Club for Growth and Tea Party Patriots are targeting Republican senators like Lisa Murkowski, Susan Collins, and Rob Portman, who opposed one or more versions of the GOP bill. Several others face serious primary challenges from irate activists. A Republican donor from Virginia Beach has even sued the party, claiming its inability to terminate Obamacare constitutes fraud.
This all presents an interesting question. Will the failure to expunge President Barack Obama’s signature legislative achievement cost Republican candidates in elections for federal office over the next few years?

It’s just one bill … right?

If we think of this episode as merely the inability to pass a single bill, it is difficult to imagine the AHCA’s defeat making much of a difference. As elected representatives are wont to do, Republican legislators gauged their constituents’ views and voted accordingly.
Most of the 20 House GOP members who voted “no” came from districts with relatively few conservative voters, and the rest of those Republicans already had a history of bucking the party — just like John McCain in the Senate. In other words, the specific Republicans who voted “no” probably did so because they think a large number of their voters actually wanted them to.

But Obamacare hurt Democrats at the polls — will it hurt Republicans too?

Democratic politicians who voted for Obamacare in 2009–10 suffered at the polls in the 2010 midterms, costing them votes and, by one analysis, around 25 seats — enough to give Republicans the majority.
But Obamacare repeal is different from Obamacare passage in two important regards.
First, non-repeal is the absence of action and therefore a failure to change the status quo. Republican voters might be upset that their congressional party did not kill the policy, but that surely is not the same as establishing it in the first place. It was Democrats who did that, and they presumably maintain significant “ownership” of any future problems in the health-care sector.
Second, President Obama signed the Obamacare bill (the Affordable Care Act) in March 2010, only eight months or so before the midterms. Republicans aborted their effort much earlier in the Congress and therefore at a point considerably more distant from future elections. A lot can happen between now and November 2018.

But Republicans tied themselves to repeal!

Still, this wasn’t just a vote. Republicans have been trying to reverse Obamacare for seven years. There have been over 50 votes in the House to repeal one aspect or another of it. Getting rid of the ACA was a central feature of the legislative agenda of the current 115th Congress, and the failure has had significant negative effects on the remaining items the Republican leadership and White House would like to see passed, particularly tax reform.
Research shows majority parties in Congress pay a price at the polls for failing to pass their legislative agenda. The public expects the legislature to be productive and use policy to solve economic and social problems. Over the past 40 years, as the parties have polarized and Congress become more partisan, Americans have increasingly associated the institution’s collective performance with its majority party. If the Congress isn’t doing anything to change the country, it must be the Republicans’ fault. Obamacare repeal was a pivotal test of the party’s capacity to govern.

Or do voters mostly care about their own lives and wallets?

But there’s also an argument that it is the effects of government action that really matter to voters. A veritable library of research reveals the electoral performance of a governing party is closely related to the country’s general health, largely the state of its economy. By virtue of its partisan connection to the president, during unified government the congressional majority will pay for bad times and be rewarded for good ones — although these effects tend not to be symmetrical (the American public prefers retribution).
Policy is nothing but an instrument, and Americans respond to the impact it has on their lives. They do not pay particular attention to the process of making it.
In this way, Obamacare caused Democrats problems in 2014 and 2016. Many Americans were clearly pleased to gain coverage, but much of that feeling was dampened by the high premiums, deductibles, and co-payments that accompanied the introduction of the ACA. For those who already had insurance, these cost hikes were especially bad news — average policy premiums more than doubled between 2013 and 2017 in 24 of the 39 states that use the national exchange.
The danger for Republicans here is that Trump now has an expressed strategy to let Obamacare die through neglect. His administration plans to do nothing to prevent insurers hiking premiums and leaving many markets across the country. Despite his assertions to the contrary, many Americans may now believe he and his party are responsible for health care policy.
And — exhibiting their innate status quo bias and temperamentally conservative approach to change rather than a deep love of the program — Americans are increasingly saying they like Obamacare. A July Gallup poll reported that for the first time a slight majority of respondents approved of the ACA.

Would the GOP have been better off passing any kind of ACA repeal?

In the long term, a health care system that increases competitiveness by allowing insurers to cross state lines and that uses cost-containment rather than mandates and taxes to broaden coverage would probably be more popular than Obamacare. But passage would have meant short-term disruption and problems for Republican candidates in 2018 and 2020.
Given that “repeal and replace” now seems dead, it’s not certain how voters will treat Republicans, especially those who voted against it, in 2018 and beyond. Will they think of the failure to repeal as a failure to govern? Will they punish Republicans for high health-insurance prices? Or will voters have more pressing issues on their minds when the next election rolls around?