Over the past few years, it's become fashionable among many political experts to deny that policy substance plays much of a role in motivating the electoral choices of the American public. The dominant picture of citizen behavior in contemporary accounts is that of a crude tribalism, in which individuals' salient social or cultural identities motivate them to develop a simplistic but powerful affinity for a favored party—and an even stronger antipathy for the opposition—that subsequently determines their normative, and even factual, political beliefs. A number of my fellow political scientists are fond of quipping on Twitter that "all politics are identity politics" and that "negative partisanship rules everything" whenever evidence arises of such phenomena at work.
Like any pithy aphorism, these observations contain substantial, but not total, truth. Today's electorate is indeed strongly partisan in its candidate preferences, and much of this party loyalty is driven by an increasingly bitter feeling toward the other side (rather than a more positive view of one's own party). Many Americans do perceive political conflict as involving competition among social groups, and their own group identity often plays a powerful role in determining which partisan team they join and which they scorn.
But a theory of voting behavior that stops there cannot account for every important development in politics today, and the apparent demise of Mitch McConnell's health care bill in the Senate late Monday is one key example. There will no doubt be numerous inside-baseball reports and analyses about how and why the legislation has failed (at least so far) to attract the necessary support. But it's also worth stepping back and looking at the big picture. The largest single obstacle that the Republican Party has faced in repealing the Affordable Care Act has been the policy preferences of the American people.
While the ACA itself proved to be a divisive measure, most of its specific provisions have consistently enjoyed strong popular support. Moreover, repeal faced the same problem any other attempt at welfare state retrenchment creates: how does a political party revoke benefits from sympathetic current beneficiaries without provoking a serious popular backlash? Prior to Trump's election, Republicans—including Trump himself—could sidestep these dilemmas by keeping their alternative health care proposals vague and implausibly attractive. Once the GOP was compelled to write an actual bill, however, it unenthusiastically produced a set of policies that were almost historic in their unpopularity. Even Republican voters reported lukewarm-at-best attitudes towards the positions of their own party leaders—demonstrating that tribal loyalty still has its limits despite our unusually polarized climate.
If Republican members of Congress thought that mere group solidarity ruled the electorate, they would have resurrected the repeal bill that passed the House and Senate in 2015 (only to be vetoed, as expected, by Obama), quickly enacted it on a party-line vote last January, and moved on to other business—secure in the belief that any supporters who subsequently lost health insurance access could be easily convinced that their favored party was not to blame. Instead, the GOP embarked on a protracted, and so far unfulfilled, struggle to reconcile its ideological predispositions with the substantive demands and anticipated responses of the broader electorate. Donald Trump's bully pulpit and Mitch McConnell's tactical acumen have not yet proven able to overcome the suspicion among a critical mass of officeholders that politicians who defy the will of the public on important national policy issues risk popular retribution at the next round of balloting, regardless of the party label next to their name.