IT HAS been called “the most dangerous piece of legislation ever passed”, “as destructive to personal and individual liberties as the Fugitive Slave Act” and a killer of women, children and old people. According to Republican lawmakers, the sources of each of these quotes, the Affordable Care Act (ACA), or Obamacare, is a terrible thing. Since it was passed by a Democratic Congress in 2009, it has been the bête noire of the Republicans. The party has pushed more than 60 unsuccessful Congressional votes to defeat it, while the Supreme Court has been forced to debate it four times in the act’s short history. Obamacare was also at the heart of the two-week government shutdown in 2013. Why does the ACA attract such opprobrium from the right?

Republican distaste exists for ideological, economic and historical reasons. Start with the ideological. The fundamental mechanism behind Obamacare—that Americans who can afford to buy insurance directly from a provider are charged higher premiums to help to pay for the subsidies provided to those who buy their coverage from government-run marketplaces—is the sort of redistributive economics that is anathema to the party of small government. Many conservatives, including Tom Price, Donald Trump’s pick as health secretary, see the drive for universal insurance as evidence of government meddling in the private doctor-patient relationship.

Next, they argue that the economics of Obamacare do not stack up. This is contentious. On one hand, the proportion of Americans without any sort of health insurance has declined from a high of around 16% in 2010 to 11% in 2016. New numbers from Gallup, a pollster, suggest that the uninsured population among low-income white people without a college degree has dropped from 25% in 2013 to 15% this year. A large group that voted for Mr Trump is also among the biggest beneficiaries of Obamacare. On the other hand, premiums are set to shoot up in 2017, by an average of 22%. Many insurers have lost money on the exchanges as customers have been older and sicker than they expected. Insurers are, in turn, passing on this cost to better-off Americans. Republicans argue that it represents the beginnings of market failure: higher prices will deter healthy, young Americans from signing up, which means insurers will make further losses, which means prices will rise again and so on, until the system collapses. The government maintains that premiums are what the Congressional Budget Office expected they would be, prior to the launch of Obamacare.

Lastly, many on the right view the ACA as the latest round in a multi-generational fight against state-proffered health care. Early in his presidency, in 1945, Harry Truman called for an “expansion of our existing compulsory social insurance system” to include health care for every American. The American Medical Association led the charge against it, and its PR firm coined the perfect phrase to sink it: “Socialised medicine”. It was political dynamite in a furiously anti-communist age. When the Republicans seized control of Congress in 1946, the policy was dropped. The government used tax breaks to encourage firms to offer private insurance plans. Workers took them up and health-care provision became entwined with employment. Subsequent Democratic presidents—Lyndon Johnson, Bill Clinton, Mr Obama—have pushed the government further and further towards universal health-care provision, but the resistance has been strong. The label of socialised medicine stuck as fast to Obamacare as it did to Truman’s plan. Mr Price may well resurrect it again in 2017.