It took former President Barack Obama and his Democratic backers more than a year to pass the Affordable Care Act, a slow and painstaking process that allowed plenty of time for a fierce backlash to ignite, undermining the law from the very start.
Republicans are trying to avoid that pitfall as they attempt to fulfill years' worth of promises to repeal and replace Obama's law.
After going public with their long-sought bill a week ago, House Republicans swiftly pushed it through two key committees. They hope to pass the legislation in the full House during the week of March 20 before sending it to the Senate and then, they hope, to President Donald Trump — all before Congress can take a recess that could allow town hall fury to erupt.
Democrats are crying foul, accusing Republicans of rushing the bill through before the public can figure out what it does. Republicans dispute the criticism, arguing that their legislation enshrines elements of a plan House Republicans worked on for months last year and campaigned on under House Speaker Paul Ryan, R-Wis.
"We offered it up in June. We ran on it all through the election. And now we've translated it into legislation," Ryan said.
Yet after seven years of Republican promises to undo Obama's signature health law and without ever uniting behind a plan to achieve that, the fact that they produced a bill at all came as something of a surprise.
And now, after months of confident predictions that Republicans would not be able to get their act together on health care, Democrats find themselves wondering anxiously whether the GOP could actually succeed in wiping away those arduous months of work from the dawn of the Obama administration.
"Nobody believed Republicans had a bill," said the No. 2 House Democrat, Steny Hoyer of Maryland, "until Monday night."
It's a far cry from eight years ago, when Democrats held countless hearings and debated at length, in public and private, how to enact the most significant changes to the nation's health care system in a generation.
Shorter process, shorter bill
While Republicans are not trying for bipartisan support on their repeal bill, Democrats spent arduous months in the Senate with a bipartisan working group of three Republican and three Democratic senators, known as the Gang of Six, trying to agree on a bipartisan bill in the process that led to passage of the Affordable Care Act along strictly partisan lines. That effort ultimately failed.
The GOP legislation is 123 pages long. The Affordable Care Act was more than 900 pages.
"We held hearings and we just spent seemingly endless hours working it over — very different from what the Republicans are doing," said Rep. Sander Levin, D-Mich.
To be sure, creating an enormous federal program requires more time and effort than jettisoning some pieces of an existing one while replacing others with new, or in some cases retooled, conservative-friendly solutions.
The GOP legislation would eliminate the current mandate that nearly all people in the United States carry insurance or face fines. It would use tax credits to allow consumers to buy health coverage, expand health savings accounts, phase out an expansion of Medicaid and cap that program for the future, end some requirements for health plans under Obama's law, and scrap a number of taxes.
Republicans have proceeded thus far without official estimates on how much the bill will cost or how many people will be covered, though it's expected to be millions fewer than under Obama's law. The Congressional Budget Office estimates are expected Monday, and that could affect Republicans' chances.
Divisions remain
Despite the momentum claimed by GOP leaders and the White House, deep divisions remain in their party. Conservatives argue that the legislation doesn't do enough to uproot the law. Other Republicans express qualms about the impact on Medicaid recipients in their states. Some Republicans accuse Ryan and House GOP leaders of moving too quickly.
"We should have an open process, we should allow all of the members to amend legislation, within reason," said GOP Rep. Justin Amash of Michigan, a perennial leadership foe.
But Democrats paid a price for their lengthy process, and there was second-guessing even then over the length of time Obama allowed the Senate's Gang of Six group to spend in its ultimately fruitless quest. As the months dragged on, public opposition grew. Over Congress' August recess in 2009, that rage overflowed at town halls that spawned the tea party movement, which would take back GOP control of the House the next year.
There's little question that if the GOP process were to drag out for months, especially over a long congressional recess, a similar dynamic could emerge, especially given the consumer and senior groups that have lined up against the legislation and the energized Democratic base already on display at marches and town halls this year.
If Republicans succeed in shoving the bill through this month, such opposition will have less time to make itself felt.
Instead, even some congressional Republicans are expressing some amazement at finding themselves, eight years later, undoing the law Democrats forged through those many months of turmoil and debate.
"I'm pleasantly surprised," said GOP Rep. Joe Wilson of South Carolina, who gained notoriety for yelling "You lie!" at Obama during a health care speech to Congress in 2009.
