Republicans are in charge. So why can’t they deliver on healthcare?

For the better part of a decade, “repeal and replace” has been Republican gospel, a political talking point and policy manifesto.

Other issues that long served as the glue holding together the disparate GOP coalition — free trade, a deep and abiding suspicion of Russia, “traditional family values” — have loosened their grip on the party and its voters.

But the quest to repeal the Affordable Care Act, or Obamacare, as it has come to be called, and replace it with a Republican substitute remains a fundamental tenet of party faith.

The problem is delivering.

Ever since the Affordable Care Act became law in March 2010, Republicans swore themselves to eradicating the legislation, a capstone of more than half a century of Democratic efforts. All they needed, they insisted, was the power to do so.

With a majority in Congress, but lacking a president of their own party, GOP lawmakers tried — or at least went through the motions — dozens of times, voting for repeal with the certainty that there would be no practical effect. President Obama stood in the way of any rollback and resultant harm, so Republicans, in effect, enjoyed a free pass.

Now, with Donald Trump, a fierce critic of Obamacare, in the White House, Republicans finally have the chance they hoped for — though some might wish they hadn’t. It’s been nothing but headaches.

Trump, to the extent he has engaged, has sent scattered and confusing signals. He orchestrated a Rose Garden ceremony to mark House passage of a healthcare bill, then called it “mean” and suggested the Senate could do better.

In the Senate, Republican leader Mitch McConnell tried to stampede through legislation before lawmakers left town for their Fourth of July recess, only to face a revolt within his party. A vote has been put off indefinitely.

Back home, many GOP lawmakers observed the holiday, a time devoted to celebrating the nation’s founding principles of accountability and self-government, by avoiding constituents and ducking their healthcare questions.

How and when the legislative effort ends is anybody’s guess. But it certainly won’t get any easier from here.

Republicans control both houses of Congress and the White House. So what’s the hang-up?

The stakes are much higher now that GOP lawmakers are voting on legislation that could, with enough support, actually take effect.

It’s an awful lot easier to attack and play to your political base when you have no worries about accountability, as Republicans did when they simply wished to score political points, than it is to constructively pass legislation having real-world consequences.

So it’s all just political hoo-ha?

Not really. There are, in fact, deeply rooted principles at stake. Democrats fundamentally believe it is government’s role to ensure at least a baseline decency for its citizens, seeing to it that people are fed, sheltered and cared for when they grow ill, even if they lack the means to do so themselves.

Republicans fundamentally believe that federal programs have grown too big and overweening, providing not just a safety net for the truly needy but a costly and ever-expanding web of services that sap initiative and that often would be better left to business and the free-enterprise system.

And?

And furthermore, healthcare is an issue fraught like no other. For many, it is a matter of life and death. So there is an added emotionalism to the debate.

So it’s all high-minded principle?

Not exactly. You can’t remove the politics from an inherently political process.

Many House members passed an admittedly unpalatable piece of legislation because they felt they had to do something after all those years of promises. So they approved their version of repeal-and-replace as a starting point, leaving it up to the Senate to make improvements.

So did the Senate improve it?

Depends on your perspective. The Senate version does make some changes from the House bill. It would, for instance, provide funding to fight the nation’s opioid epidemic and help shore up struggling state insurance markets.

At bottom, however, it would have the same practical effect as the House legislation, providing less money for health insurance and resulting in tens of millions fewer people having insurance coverage.

There is one big benefit for lawmakers weighing the legislation, however.

What’s that?

Most of the major cuts to healthcare programs would not go into effect until after the 2018 midterm elections and the 2020 presidential race.

That should buy off enough votes for passage.

Gracious, aren’t we cynical!

There are very practical reasons why some GOP lawmakers have criticized the Senate bill. Some, like Maine’s Susan Collins and Nevada’s Dean Heller, worry about the impact it would have on the needy in their states who have come to rely on the coverage they enjoy as a result of Obamacare.

Others, like Texas’ Ted Cruz, Wisconsin’s Ron Johnson, Utah’s Mike Lee and Kentucky’s Rand Paul, feel the legislation doesn’t go far enough in repealing Obamacare and the onerous burden they believe it places on business and consumers.

The difficulty for McConnell, who can only lose two Republican votes if he hopes to pass the healthcare bill, is squaring that circle. Concessions he makes to please Collins and Heller could make Cruz, Johnson, Lee, fellow Kentuckian Paul and other conservative lawmakers even less amenable to supporting whatever he comes up with.

Where are Democrats in all this?

Watching and snickering. They passed Obamacare without a single Republican vote and have politically owned the healthcare issue, for good and mostly bad, ever since. Anything and everything that has caused distress — the increased cost of medical treatments, higher premiums, a middling economic recovery, “Baywatch” tanking at the box office — has been blamed by the Republicans on the ravages of Obamacare. (OK, “Baywatch” flopped all on its own.)

Now it’s Democrats’ turn to watch as the GOP struggles with the incredibly complex issue and suffers the weight of crushingly negative opinion polls.

Didn’t McConnell suggest he would negotiate with Democrats if Republicans failed to pass a healthcare bill on their own?

Yes he did. And the fact it was meant as a threat says a lot about the state of our politics today.

mark.barabak@latimes.com

@markzbarabak

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