The president's health care overhaul may already be done, but some Republicans want it undone.
Just ten months after the Democrats' reform legislation was signed into law — and before most of its major elements have been implemented — the House of Representatives is kicking off the new year and the new Congress by trying to undo what was done last year.
Next week, the House, now under Republican rule, will vote to repeal the Patient Protection and Affordable Care Act (PPACA) signed by President Barack Obama last March.
Will that vote be the beginning of the end for “Obamacare” or simply a display of Republicans’ commitment to keep faith with the voters who elected them last November?
Republicans campaigned last fall on a pledge to “repeal and replace” the health care law. Exit poll interviews on Nov. 2 showed that, while voters in general are divided about whether the law should be scrapped, a majority of those age 65 and older say it deserves to be nixed.
Buoyed by the enthusiasm of GOP voters, Republicans’ recapturing of the House means that the lower chamber is set to easily pass the repeal.
Repeal to die in the Senate
But, since Democrats still control the Senate, the vote won’t result in any change in the law.
Senate Majority Leader Harry Reid could simply keep the repeal from coming to the floor at all, or if it does come to a vote, the Democratic majority will defeat it.
While the push to completely repeal the bill is destined to fizzle in the coming weeks, GOP leaders could use the House’s power of the purse to choke off federal funding for the implementation of the law, effectively chipping away at its key provisions.
“Next week’s vote is largely symbolic, but future votes could be more consequential,” said Paul Van de Water, a health care economist at the liberal think tank, the Center on Budget and Policy Priorities. “A real showdown could occur if the House Republicans attempt to use the appropriation process to deny funding to the Department of Health and Human Services and the Department of the Treasury for implementing the health reform law.”
House GOP leaders haven’t yet tipped their hand on whether they’ll use that tactic.
Republicans 'keeping their word'
Dean Rosen, a former health care advisor to former Senate Majority Leader Bill Frist and a lobbyist with the Washington firm Mehlman, Vogel, Castagnetti, said that for Republicans in the House the repeal is “a matter of keeping their word with the voters — doing what they say, and saying what they mean.”
“Saying it is purely symbolic diminishes the importance of doing this now,” he added. “They really believe it; it’s not just about political posturing.”
(Meanwhile, suits filed by several state attorneys general challenging the law's constitutionality are moving through the federal courts. But they may not be resolved until next year.)
So Democrats find their signature accomplishment of the last two years under siege once again, but there are potential benefits to them in renewing the discussion. The repeal effort has allowed them to re-argue their case for the law and accuse Republicans of attempting to retain only the parts of the legislation that may be popular with voters.
For example, GOP leaders have instructed House committees to write legislation that will keep one of the most popular provisions of the law: insurance coverage for every person regardless of preexisting medical conditions.
But if Congress were to kill the individual mandate — the requirement that people buy insurance — some would wait until they got sick to buy insurance.
If the pre-existing condition requirement remained in place, insurers would end up covering more and more sick people and not getting premium payments from enough healthy people.
Refresher course: Health Care Economics 101
So the House debate is Health Care Economics 101 all over again, just as in 2009.
Paul Fronstin, an analyst at the Employment Benefit Research Institute, a nonpartisan research group in Washington, explained as Congress began debating health care in 2009, “If we’re going to require insurance companies to sell people insurance independent of their health status, then everyone has to be in the system.”
Democrats also argue that if Republicans truly cared about deficit reduction, they’d keep the health care law intact.
Rep. Debbie Wasserman Schultz, D-Fla., said Tuesday that “the first thing out of the gate they (the Republicans) are planning to do is try to repeal health care reform, which explodes the deficit.”
She and other Democrats point to last year’s estimate by the Congressional Budget Office that the legislation would produce a net reduction in deficits of $143 billion from 2010 to 2019.
On Thursday the CBO released a preliminary estimate of the effect repealing the law, saying it “would probably increase federal budget deficits over the 2012–2019 period by a total of roughly $145 billion.”
Future cost cuts uncertain
But the legislation’s effect on future deficits is somewhat speculative. Major cost-cutting is not scheduled to begin until 2014 and beyond — and the future cost cuts are uncertain, depending on the resolve of future Congresses to enforce them in the face of protests by people whose benefits would be less than they expected.
Richard Foster, the chief actuary of the Centers for Medicare and Medicaid Services, warned last year that some of the expectations of cost savings — especially those from assumed improvements in the efficiency of hospitals — “may be unrealistic.”
That leaves the GOP caught in a bind: they were elected on a platform that combined deficit reduction with opposition to Medicare cuts.
But how can Congress significantly reduce deficits without reducing Medicare’s growth? Medicare keeps growing at a faster pace than the nation’s income. In 2009 Medicare spending grew by nearly 8 percent even as the American economy shrank by 2.6 percent.
House Budget Committee chairman Paul Ryan has offered a way to control Medicare’s growth, starting in 2021, by using vouchers to replace the current open-ended Medicare payments and by gradually raising the eligibility age for Medicare from 65 to 67.
Speaker John Boehner and other GOP leaders haven’t endorsed the Ryan plan.
“The repeal vote is easy compared to what you do to 'replace,'" Rosen said. He said, "There’s going to be some effort to put up Republican ideas" whether it’s the Ryan plan or a plan Boehner offered last year which stressed curbs on medical malpractice lawsuits and other reforms to make insurance less expensive.