[问答] 美国共和党为何不通过医保法案？

Here's why:

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Claire J. Vannette, mouthy broad 2013 U.S. Federal Government Shutdown: Why do Republicans dislike Obamacare so much -- enough to shut the government down over it? Why are some terrified of it?
Votes by Yanliang Han, Doug Dingus, Ido Sarig, and 31 more.

As I understand it, the big three reasons are:

1. It penalizes people who don't purchase something. That's tantamount to ordering them to purchase it. I'm not a Republican, and I'm still not comfortable with the idea of the government ordering me to buy a product.

2. It places a bunch of new restrictions on private companies. For example, it is no longer legal for insurance companies to deny coverage to people with preexisting conditions, even though it's very expensive for them to provide those people with coverage, and they may end up losing money on the deal. Mind you, the way I understand it, the insurance industry agreed to this rule as a condition of having a bunch of new compulsory customers, but it's still a regulation, and Republicans tend to dislike a lot of regulations.

3. The incentives created by the law may screw some people over. Many employers are now required to provide health insurance to their full-time employees, or pay a fine. This creates an incentive for those employers to cut employees' hours to part-time. They'd have to hire more people, so maybe some unemployed people could get part-time work, but some full-time workers would be bumped down to part-time and lose income. We could see more people working multiple part-time jobs, which is pretty hellish, in my experience.

Keep in mind that this law is HUGE and has many, many moving parts. I'm sure someone else can provide an exhaustive list of common Republican complaints about it. I recall something about a tax on medical devices, I think. But these are the big points that I hear again and again, and aren't patently false, like the "death panels" nonsense.

Ian McCullough, Isn't that an assumption that I have experience in questions that contain assumptions? 2013 U.S. Federal Government Shutdown: Why do Republicans dislike Obamacare so much -- enough to shut the government down over it? Why are some terrified of it?
Votes by Gary Stiffelman, Marc Bodnick, Michael Lee, and 7 more.

I'm not a member of the Republican Party, but was asked to answer. This question was asked on September 21, 2013. I assume that this question has been asked in the context of the House bill that links the ACA & the Federal Budget that could potentially lead to a government shut down on October 1st. I also feel that the pros and cons of the bill have been thoroughly parsed and debated in this virtual tavern we call Quora; people can browse through existing questions and answers associated with topics like the Patient Protection and Affordable Care Act (Obamacare) and Healthcare Reform. (To briefly summarize, though: the biggest objections revolve around the employer mandate, the individual mandate, the Medicaid expansion, and the tax provisions that are supposed to fund the Federal components. Some objections are practical and some are ideological.)

Moving on.

I think that it is not entirely correct at this point to say that Republicans as a whole are terrified of Obamacare. The law passed Congress. It survived a Supreme Court case (National Federation of Independent Business v. Sebelius) and survived the2012 U.S. Elections. The general consensus – even amongst Republicans – seems to be that, for the time being, this is a done deal. That's not to say that they support the bill now, but they aren't interested in scorching the Earth to defeat it. What Republicans are terrified of is having to raise money to defend their seats in a primary race where they are attacked by a well-funded Tea Party and right wing, and then either loose the primary or go on to face a Democratic contender in a general election, which will require even more fundraising effort.

It was 43 House Republicans that first officially backed the Continuing Resolution to threaten a shutdown over defunding Obamacare. The final vote tally was 230-189. (Click here for the results of Roll Call 478.) The other 190 Republicans who supported the resolution (including the 3 who didn't vote) know that the defunding provisions are going to get stripped out in the Senate. Since they've already voted 42 times to repeal the ACA, it's a bit late to take a "principled" stand against the most determined opponents of the act. In addition, Senators Senator Ted Cruz and Mike Lee have been making lots of public noise, further adding to the right flank political pressure.

In terms of the raw political mechanics, it seems to be an interesting collision of circumstances and unintended consequences. The House ban on earmarks (implemented by John Speaker Boehner in 2010) effectively removes carrots that the party leadership can offer to buy caucus members'compliance, and the Citizens United v. FEC SCOTUS decision (also in 2010) basically took the stick of campaign financial support and moved it from the RNC to 501(c)(4) SuperPACs backed by anonymous donors.

The ultimate imperative in U.S. Politics is to win elections. Senators have six year terms that give them some chance to build up track records for their constituents and to build relationships. Congresspeople in the House only have two year terms, and have to spend a lot of time raising money to keep their job for another term. Any Republican member of the House who supports Obamacare will have a very difficult and very expensive time keeping their job.

Some other answers related to this topic from me:

My personal agenda for healthcare in America is to see the end of the employer-centric system for the provision of insurance while pushing towards affordability for all citizens. The PPACA take a number of steps in the wrong direction (most obviously the employer mandate), but a big step in the right one by establishing the exchanges as an alternate viable mechanism for shopping and selection of insurance. There's a lot more bitter fighting that needs to happen over Tax Reform, Medicare Total Overhaul, and a big shift in social attitudes on death + dying + end-of-life care.... but it's a start.Ian McCullough's answer to 2013 U.S. Federal Government Shutdown: Have certain Senate Republicans abandoned their conservative base by refusing to defund Obamacare?
Ian McCullough's answer to Supreme Court Upholds The Affordable Care Act (June 2012): What do people think about the Supreme Court's ruling on the Affordable Care Act?
Ian McCullough's answer to Why does the USA diverge from the practice of giving free or almost free health care as exists in every other developed country in the world?Ian McCullough's answer to Will America ever have a universal healthcare system?