The health-care bill now before the Senate has been shaped by a number of lessons that Republicans have learned in the course of a six-month, bicameral legislative process. It is a function of some things they've come to prioritize about the individual health-insurance market and Medicaid, and some things they've learned about the intricacies of the Byrd rule and Senate procedural constraints. But mostly it is a function of something they have learned about themselves: After seven years of saying they want to repeal and replace Obamacare, congressional Republicans have been forced to confront the fact that many of them, perhaps most, actually don't quite want to do that.
That doesn't mean that most of them never did. The case for repeal was strongest in the three or four years between the enactment and implementation of Obamacare. As more time passes since the beginning of implementation three and a half years ago, and more people's lives become intertwined with the program for good and bad, the case for addressing Obamacare's immense deficiencies by repeal weakens as a practical matter in favor of a case for taking them on by alteration.
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