Earlier this month Senator Orrin Hatch (R-UT) spoke for more than a few conservatives when he declared “We’ve been working to dismantle Obamacare. We have to fight this terrible law that’s a threat to liberty itself.”
Over at the New Republic, Jon Chait offers two reasons why this won’t happen: 1) the American people don’t want it to happen and 2) Republicans don’t want to be voted out of office.
Why isn’t the party lining up behind the ideologically purer King bill? Most likely, Chait suggests, “they're looking at polls that show that health care repeal is not very popular.
“The latest Kaiser Foundation poll finds that 60% of Americans either support the ACA or prefer that it ‘be given a chance to work with Congress making revisions as needed.’ Just 27% support repeal. The most recent NBC/WSJ poll asks:
“And, would you be more likely to vote for – a Democratic candidate for Congress who says we should give the new health care law a chance to work and then make changes to it as needed, or a Republican candidate for Congress who says we should repeal the new health care law entirely and then start over?’”
“51% pick the Democrat, 44% pick the Republican. This was in a poll showing a plurality (45-43) preferring a Republican-controlled Congress,” Chait explains. “In other words, framing the election around health care repeal shifts the debate from +2 for the GOP to +7 for the Democrats.”
It’s worth noting that the poll acknowledges a 3.1% margin of error—plus or minus—making the Democrats’ 45-43 plurality shaky. On the other hand, over the past year, Republicans have been gaining on this question, with the share preferring a Republican-controlled Congress rising from 39% last summer to 45% today. So the fact that 51% would vote for the Democrat who wants to give health care reform a chance is significant.
Chait concludes: “is the GOP leadership treading cautiously on health care repeal because they're squishes? No, it's because they want to win the election.”
What will happen after the November elections? I predict that conservatives will move to “dismantle” health care reform. But I also think that as 2010 draws to a close, unemployment will remain high, the cost of care will continue to rise, and more and more Americans are going to be very worried that they won’t be able to afford healthcare. They will be grateful that the government has created a safety net. They will not want Congress to rent that net.
Moreover, the NBC/WSJ polling suggests that as time passes, and Americans learn more about what is actually in the legislation, the number supporting reform has been growing steadily. In June, 40% said it was a “good idea,” up from 33% a year earlier, and up from 36% in March. In the meantime, the share of respondents who “don’t have an opinion” has dropped from 30% a year ago to 16% today.
Granted, the number who think that reform is a “bad idea” also has risen over the past year, but since the legislation actually passed, the share of respondents who oppose the plan has fallen, from 48% in March, to 44% today.
Finally, as Chait suggests, Republicans arguing for repeal will be seen as the radicals, calling for more upheaval, and more uncertainty. Americans are weary of the vitriolic ideological battles that have been consuming legislators’ time and attention. They want Congress to create jobs, extend unemployment benefits, bring an end to unwinnable wars in the Middle East, and focus on the domestic economy
first, Republican simply won’t have the numbers to repeal reform, or even bring it up. so only way you can repeal is if significant numbers of Democrats decide it was a bad idea. that’s how medicare catastrophic coverage was repealed in 1989.
second, Republican don’t want to repeal everything for several reasons. from a cynical political perspective, that would give them ownership of the resulting problem. also there are provisions that are wildly popular, like covering adult kids.
the real issue here is not whether you can avoid repeal in the short-run. that’s not even a heavy lift. rather it is whether you can build popular support over time. time will tell.
Even Republican supporters who are against the health reform bill likely do not want repeal because it will involve more time being spent on the topic of health reform. This is especially the case when there are other pressing problems like unemployment and problems such as these were ones that the Republicans were originally telling the Democrats they should spend time on instead of health care.
Health Affairs Blog reported on Rep. Michael Burgess’s (who is also a physician) preferred strategy to keep the law in place but to defund it. His other preferred strategy is to keep the fee-for-service system and eliminate the Medicare Independent Payment Advisory Board. Death by a thousand cuts.
http://healthaffairs.org/blog/2010/07/01/rep-burgess-gives-physicians%e2%80%99-take-on-new-health-care-law/
We shall see what happens when you pass policy strictly along partisan lines. When they are back in power,there is zero incentive to make the previous party’s policy work. You will see parts defunded. Unpopular parts possibly go such as the individual mandate, that or elimination of the penalty, basically doing the same thing. You eliminate what is unpopular with no concern about the total effect, because it’s not your policy. As far as voting against the wishes of the voter, that’s not far-fetched. The Democrats did that passing reform in the first place.
Wellescent, Jim
I agree. If Congress spent another year debating whether we should have health care reform many Americans would just want to tear their hair out. (Or tear their Congressman’s hair out.)
There are other very important issues– unemployment, the wars . .
A decision has been made, and I think you’re right, even those who are not entirely happy with the decision really don’t want to see Congress go through the whole process again.
Jim –
The Republicans don’t have the votes now, and I don’t think they will have the votes after the November elections, though if Congress actually decided to change the filibuster law . .
But you’re right, if Republicans repealed then they would “own” the status quo: millions uninsured and health care costs rising 2 or even 3 times faster than GDP.
The real question, I think is not now many Republicans and moderate democrats will be in Congress after the Nov. elections, but how many die-hard conservatives will be in Congress. There are those who object to gov’t reform of health care as a matter of ideology, and wouldn’t care about the practical consequences of repeal, even for their own party.
What people forget is that the alternative to reform is what we have now–and that’s unsustainable.
In terms of building popular support over time–
I don’t think reform is going to be “popular” anytime soon–except among the working poor who didn’t qualify for Medicaid in the past and now will either qualify for Medicaid or good subisidies that make insurance affordable– and among those who couldn’t get insurance because of pre-existing conditions, and now will be insured.
Many upper-middle-class Americans (say couples earnign more than $75,000) will find that don’t qualify for a subsidy, and that if they don’t have employer-based insurance, now they will have to buy
comprehensive insurance. (Comprehensive insurance may be more expensive than the skimpy insurance they have now. Many people don’t realize how little coverage they actually have now because they’ve never been seriously ill.)
Younger Americans, in particular, will not be happy about begin forced to buy comprehensive insurance (or pay a penalty)-even though, in fact, they will be safer. And I suspect that, in order to make the system work, those penalties will have to be raised. This will not be popular.
Some of the highest paid physicians will see their incomes drop as both Medicare and insurers move away from paying for volume. They won’t be happpy, and they’ll complain to their patients, who won’t be happy.
Under reform, patients will be getting more information about risks as well as benefits of tests and treatments from many sources.
People who like to think that everything will be fine if you just get tested often enough, and catch diseaes early enough, will find out that just isn’t true. They won’t be happy with the news–or a doctor who explains why they might not want a PSA test,or even a mammogram.
Change is hard. But we really don’t have a choice, unless we want to become a 3rd-world country where only about 20% of the population receives pretty good care–and pays royally for it.
I suspect we’re looking at a fairly rocky transition period of at least 10 years. During those 10 years, some people will be happy with the changes–including doctors, particularly doctors under 40 or so—as well as patieints who recognize that the system is becoming more rational.
Jenga–
The problem with repealing or defunding parts of the other party’s policy is that, as Jim points, this leaves the Republicans holding the bag–responsible for the consequences.
For instance, if you get rid of the mandate–or the penalties –then insurance premiums sky-rocket.
This is because, Under the new law, insurers are required to cover everyone who applies, at the same price, regardless of pre-existing conditions. (They can charge older people more, but they can’t charge sick people more.) If there is no mandate, everyone will wait until they are sick to apply for insurance..
Trying to cover a pool of sick people will be impossible unless insurers double or triple premiums, making insurance unaffordable for most of us.
Of course Republicans could repeal the part of the legislation that says insurers have to cover everyone, despite pre-existing conditions.
But then Republicans have to explain to the milions of Americans suffering from pre-existing conditions . . .
Most of the parts of the legsilation are interdependent– try to remove one piece and you run into big trouble.
In addition, this legislation wasn’t passesd along partisan (party) lines, it was passed along ideological lines.
The Republican leadership is extremely conservative, and they made it clear to any Republican who didn’t stick to the hard-core conservative line that they would PAY. (There weren’t that many moderate Republicans to bully– Rove, et. al. pushed them out of the party long ago.)
That’s why you had an unusual situation where not a single Republican dared to cross party lines.
Meanwhile, Democrats compromised with themselves, giving up the public option, for instance, in order to win moderate Democratic votes.
We’ll see what happens in November. But polls show that Americans are a) not happy with Congress as a whole and b)feel that their Congressmen should be replaced–giving a new person a chance–whether their Congressperson is Rep. or Dem.
This suggests that incumbents on both sides of the aisle will be thrown out of office. Will the conservative REpublicans be replaced with more moderate,less ideological Republicans?
Will moderate Democrats be replaced with more progressive or more conservative Democrats?
We’ll see.
Much also depends on who comes out to vote. Will the folks who tipped the scales for Obama (Blacks, hispanics, Asians and young people) come out in large numbers?
In the 2008 elections, they discovered how much their votes can count. Will they –and friends and relatives who didn’t vote in 2008– come out in 2010?
Finally, in terms of Democrats voting against the wishes of the voter when passing this legislation, poll after poll shows that voters felt that they didn’t know what was in the legislation-they just knew it made them very nervous in various ways.
Ever since passage, support has been growing steadily.
Sometimes political leaders have to lead, as they did when passing civili rights legislation. Over time, the majority of Americans decided it was the right thing to do, but
when civil rights was being debated, a great many Americans were opposed, and not just in the South.
Repeal? No. But in the context of controlling the deficit Republican opponents and some Blue Dog Democrats will attempt to cut back on the level of subsidy for low income individuals. If they have the votes to control the budget process this approach would destroy the “universality” of the reform. If they also fail to allocate the funds for Medicaid expansion that, too, will fall by the boards. And if they do it all in the name of fiscal responsibility and deficit reduction, they will get away with it. November will determine the outcome.
Rashi–
Thanks for commenting. It is very good to hear from you.
Yes, I agree– those are the vulnerable areas in the legislation.
The poor don’t have a lobby, and few voices in Washington.
On the other hand, I believe that there are some voices in the administration who are acutely aware of and concerned about the poor.
Would Obama fight for decent subsidies for low-income Americans and expansion of Medicaid?
Obama does not want to be seen as the (African-American) president who represents the poor; he wants to be seen as the president who represents all Americans.
At the same time, I think that he would have a hard time writing off the poor. In contrast to some past presidents, he is aware that they exist–and certainly Michelle is very aware. (Here, perhaps a parallel to FDR and Eleanor– I don’t know. This is just an intuitive guess/hope).
As you say, everything really turns on the November elections. It’s not so much how many seats the Republicans take, but how many seats hard-core conservatives hold onto –or take. And whether more progressive Democrats manage to replace some incumbent Democrats.
I think this issue will eventually get to a boiling point, although many think we’re there now. I agree with my peers in healthcare, that the argument framing quality health delivery as a “right for all to have or a privilege” will make its way to the mainstream press.
This will make many uncomfortable on capitol hill as they will be forced to answer that it’s in fact, a right.
But I agree, there will be a lengthy period of unsettled debate and rancor over the current bill. However, the American public will be tired of hearing it and so I give it maybe 5 years, not 10, before we see a final product reluctantly agreed to by both sides of the aisle.
The republicans could make some inroads by using the deficit as a jumping off point for changing the bill or trying to abandon it all together. However, I don’t believe any party is savvy enough to rally behind common-sense. I really am getting more cynical these days. Thanks for the topic – Tim
stop smoking help-
The debate about whether heatlhcare is a right or a privilege has already been in the mainstream press–particularly during the first year of the Obama adminmistration
Only very conservative right wing publications (and right wing columnists) are willing to say that all American citizens don’t have a right to health care.
Two questions are likely to dominate the debate in coming years: do people have a right to all of the healthcare that they think they need? Medicare–and private insurers–will be trying to reduce waste and they will be paying more attention to unnecessary tests and ineffective treatments.
Secondly, Do the poor deserve as much care as everyone else and how much should have ot pay for it?
As Rashi indicates, there will probably be pressure to cut subsidies for low-income families. Conservatives may also try to undo the expansion of Medicaid.
Finally,some young, healthy upper-middle class Americans will object to having to buy comprehensive insurance, arguing that they don’t need it, and don’t want to help pay for healthcare for older americans. (Some say “I’ll help my mother, but not someone else’s mother.)
But in every other developed nation in the world, young adults contribute to the insurance pool to help cover seniors, knowing that when they are old, young adults will be contributing to the pool that helps them.
Ultimately, people will accept this.
I hope you’re right that the debate lasts for only about 5 years. But I think it will take 10 years to make the structural changes in how we pay for care, and how care is delivered, with a shift to evidence-based care that is not fee-for-service.
This is one of the reasons that Republicans never wanted the reform passed to begin with. IF they repeal it, the resulting system will be theirs.
As the law currently stands, in about one month, parents of children with pre-existing conditions cannot be denied coverage for the children when try to buy insurance for for their children, and in 2014 it will apply to anyone who wants to buy coverage.
Unless Republicans have an alternative to high risk pools, which are too expensive for everyone to buy coverage, they’re going to hold the label of the party that pulled health insurance away from children and adults with pre-existing conditions, as well as people who are between ages 18 and 26.
In order to repeal Obamacare which consists of front loading revenue and a 3 to 4 year delay in actual implementation leaves legislators opposed to the health care legislation with several methods as they grapple in their attempt to derail the negative impact.
Setting The Stage
Everything is mostly dependent on three factors.
First, the Republicans must regain control of Congress, otherwise the votes will not be available to modify the legislation.
Second, the economy must continue to show less than stellar performance and give reason for the public at large to be critical of the administration.
And third, the federal deficit must continue to climb.
If these three conditions are met, repeal of the legislation in whole or in part are likely.
How To Put The Genie Back In The Bottle
Since the revenue is front loaded, the easiest method will be to simply rescind the tax increases and fees used to fund the programs. It would not have to be an omnibus bill to accomplish the task of gutting the legislation, just single appropriation amendments attached to larger bills over time. Defunding the programs one by one would place the government in a corner: either give up the legislation all together, find other ways of funding, or use the remaining funds to finance a smaller plan.
Another method would be to pass amendments or add on laws that would make implementation of the legislation so onerous and expensive it would never be implemented in the first place. The Congress could even use its Constitutional muscle and demand oversight of all functions under control of federal agencies.
Unfortunately, the first three years of the legislation will be the only time these steps can be undertaken.
Jagjag 197 and for mer
jagjag 197.
You’re right. If reform is repealed more and more people will be denied insurance–or find it completely unaffordable. Reform is already beginning–if Republicans tried to undo it they would be seen as responsible for soaring health care costs.
for-mer–
The scenario you sketch is pretty unlikely.
First, the Democrats will probably retain control of the Senate. Secondly even if they lost control, President Obama would veto any attempt to repeal the funding. Republicans wouldn’t be able to muster the votes to overcome a veto.
Most voters would not support rescinding the taxes because only people earning over $200,000 (less than 5% of the population) would be affected. Most voters favor having insurers, pharma and device makers pay higher fees.
Finally,and perhaps most importantly, with unemployment high, and the economoy in bad shape, people are very concerned about not being able to afford health care. They want the safety net that only govt. can provide.
In the early 1990s, reform failed in part because the recession ended and unemployment fell. This time around that is not going to happen.