WASHINGTON – The Supreme Court’s recent rejection of a Republican attempt to smash Obamacare re-signals that the GOP must look beyond repealing the law if it is to turn the country’s health problems into a winning political issue.

Thursday’s 7-2 ruling marked the third time the court rejected major GOP challenges against former President Barack Obama’s valued healthcare reform. Stinging for the Republicans, the decision came from a bench that was dominated 6-3 by conservative judges, including three appointed by President Donald Trump.

These Supreme Court setbacks were the result of dozens of failed Republican overturn attempts in Congress. Most spectacularly, Senator John McCain, R-Ariz., Gave a thumbs down doomed Trump’s drive to wipe out the law in 2017.

Coupled with the gradual but determined public acceptance of the law, the court rulings and legislative defeats underscore that the law, passed in 2010 despite overwhelming opposition from the GOP, is likely to be safe. And it shows a remarkable evolution of the measure from a political liability that cost control of the Democratic House just months after it was passed, to a widely accepted bedrock of the medical system which, according to the government, serves more than 30 million people.

“The Affordable Care Act remains the law of the country,” said President Joe Biden, using the law’s more formal name, after the court ruled that Texas and other GOP-led states were not eligible to bring their lawsuit in federal court .

“It’s not as sacred or as popular as Medicare or Medicaid, but it will stay,” said Drew Altman, president of the non-partisan Kaiser Family Foundation. “And it has grown from an ideological whipping boy into a range of popular perks that the public appreciates.”

In interviews and written statements Thursday, more than a dozen Republican lawmakers called for controls on medical costs and other changes to highlight the GOP’s changing focus on healthcare, but none suggested further repeal. Republicans in Congress hadn’t even tabled a legal document backing the recent Supreme Court challenge.

“Practically speaking, you need 60 votes in a Republican Senate, a Republican President, right? And we tried that and we couldn’t get it, ”said Senator Bill Cassidy, R-La., A leading healthcare voice in the GOP.

Polls show the risks involved in trying to get Obama’s law abolished. A Kaiser poll showed Americans were evenly divided on the law in December 2016, shortly after Trump was elected with promises to kill him. In February 2020, 54% had a positive opinion, while 39% disagreed.

House minority leader Kevin McCarthy, R-Calif., And other Republican leaders issued a statement illustrating a line of attack the party is preparing – an attempt to tie all Democrats to “Medicare for All,” a costly plan for government-provided health care for progressives beyond what Biden and many in the party have proposed.

Congress should not “duplicate a failed health bill or, worse, move towards a unified socialist system that completely takes away options,” Republicans said.

The GOP should focus on health issues that matter to the people, like personalized care and promoting medical innovation, rather than repealing the health bill, said David Winston, a pollster and policy advisor to the GOP leaders in Congress.

“Republicans need to give clear direction on where the health system should go,” said Winston. “Don’t look back, look ahead.”

Most people have coverage either through Obama’s expansion of the government-funded Medicaid program for low-income people or through private health insurance, which has federal grants for many to help offset the costs.

One of the most popular provisions of the law is to protect people with pre-existing medical conditions through higher insurance rates that allow people up to the age of 26 to remain insured under their parents’ plans and oblige insurers to provide benefits such as pregnancy and mental health take.

Critical requirements like these are “locked in concrete,” said Joseph Antos, a health policy analyst at the conservative American Enterprise Institute. The political openness to Republicans would be if Democrats push hard on things like lowering the Medicare eligibility age to 60, because for many conservative voters, he said, “this is a sign that the government is going too far” when making decisions in the private market.

Serious problems remain, however.

Nearly 29 million Americans remained uninsured in 2019, and millions likely lost coverage, at least temporarily, when the COVID-19 pandemic broke out, Kaiser said. In addition, medical costs continue to rise and even many people with statutory health insurance find it difficult to afford their premiums and deductibles.

In response, Biden’s $ 1.9 trillion COVID-19 aid package passed in March expanded federal subsidies for health insurance premiums for those who buy coverage. His infrastructure and jobs proposal, under negotiation in Congress, calls for $ 200 billion to make it permanent instead of expiring in two years.

But his plan does not include any of his more controversial campaign proposals to expand access to health care, such as creating federally funded public health care or allowing Medicare to negotiate drug prices directly with drug companies. While these proposals are popular with Democratic voters, they face tough odds in a tightly divided Congress.

Still, Republicans preparing for the 2022 election that will rule over control of Congress must decide where their next focus will be.

A GOP strategist who has been involved in house races and who spoke on condition of anonymity to describe internal thinking said the party should focus on issues such as the economy and border security, which are seen as major voter concerns. A Gallup poll found that as of May, 21% of the public rated the economy as the nation’s biggest problem, while only 3% registered health care.

Other Republicans say the Supreme Court’s rejection of the recent overturn attempt will open the political field for them to refocus their attacks on health care on the Democrats.

“Now Medicare for All is a major health issue that will be campaigning a part,” said Chris Hartline, spokesman for the National Republican Senatorial Committee, the Senate GOP’s campaign arm.

———

Associated Press authors Alexandra Jaffe in Washington and Tom Murphy in Indianapolis, Indiana contributed to this report.