Can The GOP Deliver On Its Promise To Repeal ObamaCare? And What’s The Replacement?
The Republican strategy on health care in the wake of the Supreme Court's decision needs some tweaking.
As I noted earlier, Mitt Romney responded to the Supreme Court’s decision on the Affordable Care Act by promising to repeal the law on his first day in office. In order to accomplish that of course, the GOP will have to overcome a number of hurdles that are by no means easy to achieve.
First, of course, they will have to win the Presidency and gain control of the Senate. As we’ve seen from recent polling at the national and state level, though, the race between President Obama and Mitt Romney is tight to say the very least. While I’m sure that we’ll be getting “flash” polls about the health care decision as soon as tomorrow it will take several weeks at least for the political impact of what the Supreme Court did today can be fully evaluated, and even then that will only be the initial impact. The ACA itself, as well as the Supreme Court, are likely to become larger issues in the election than they might have been otherwise, and it’s hard to see which side benefits the most from that fact. One can make an argument that upholding the ACA will energize the Republican base and the Tea Party and bring those independents who have been skeptical of the law from the beginning into Romney’s camp. At the same time, one can make a case, as Rick Moran does in this piece at PJ Media, that today’s Supreme Court decision is a major boost to President Obama’s re-election efforts.
As for the Senate, the fact that the current Democratic majority is so slim and that the majority of seats up for grabs this year are held by Democrats suggests that the GOP has a fair chance of grabbing control of the Senate. The only problem is that, at least based on the way the races at the Senate level seem to be going at the moment, it’s likely to be a very narrow majority. Looking at the most optimistic scenario for the GOP, my estimate is that we’re looking at a 53-47 GOP majority, the more realistic GOP scenario puts the majority at a razor thin 51-49. That’s nothing to sneeze at because it gives the party control of Committee assignments and the legislative agenda, but it presents a few problems for the GOP.
We’re all familiar with the Senate’s cloture rules and the 60-vote threshold that must be reached to even get to the point where there can be a vote on the merits. Obviously, with a majority of 53 or 51, the GOP would be nowhere near where it would need to be to invoke cloture on a repeal bill. Now, there are scenarios under which some pieces of legislation could make it through the Senate without being subjected to Cloture using the reconciliation process but this would not apply to all provisions of the Affordable Care Act and even an effort to merely repeal the penalty provisions of the individual mandate could be barred from reconciliation by the Byrd Rule depending on how the Senate Parliamentarian rules on the matter. At the very least there would be a huge battle between Republicans and Democrats over Senate rules in which a situation, at most the GOP may find that it would be unable to repeal any part of the ACA without 60 votes.
Those are the practical limitations that the GOP would face in trying to repeal the law. Over at The Daily Beast, David Frum points out the political limitations that may make repeal far more difficult than Republicans seem to believe:
First, today’s Supreme Court decision will make it a lot harder to elect Mitt Romney. President Obama has just been handed a fearsome election weapon. 2012 is no longer exclusively a referendum on the president’s economic management. 2012 is now also a referendum on Mitt Romney’s healthcare plans. The president can now plausibly say that a vote for the Republicans is a vote to raise prescription drug costs on senior citizens and to empower insurance companies to deny coverage to children for pre-existing conditions. Those charges will hurt—and maybe hurt enough to sway the election.
Second, even if Republicans do win the White House and Senate in 2012, how much appetite will they then have for that 1-page repeal bill? Suddenly it will be their town halls filled with outraged senior citizens whose benefits are threatened; their incumbencies that will be threatened. Already we are hearing that some Republicans wish to retain the more popular elements of the Affordable Care Act (ACA). Which means the proposed 1-page bill will begin to grow.
Third, Mitt Romney has promised to grant states waivers from the obligations of the ACA. Not all states will ask for such waivers. Many will eagerly institute the ACA, which (let us not forget) includes large immediate grants of federal aid.
Fourth, Republicans will find the task of writing their “replace” law even more agonizing than the Democrats found original passage. The party has no internal consensus on what a replacement would look like. Worse, any replacement of the law’s popular elements will require financing. But where is that money to come from? New taxes are unacceptable. The proceeds of “closing loopholes” are already spoken for—that’s how President Romney has promised to finance his promise to cut the top rate of tax 28%. And he’s also promised to increase defense spending.
Fifth, the clock is ticking. President Obama passed the ACA in the second year of his administration. A President Romney will have to pass repeal in the first year of his, because the law goes into effect in 2014. By then, states will have to have their exchanges up and working. And states that have put themselves through that work will not be very eager to see Washington undo it. If replacement does not happen in the first 100 days, it won’t happen at all—that is, it won’t happen as a single measure, but rather will take the form of dozens of small incremental changes adopted episodically over the next 20 years.
All of these points are well taken, I believe. The fact that the Supreme Court has, after nearly two years in which many people were saying on a near daily basis that it was unconstitutional, but its imprimatur on the Affordable Care Act, it has placed a powerful political weapon in the hands of the President and his Democratic allies. As I said above, we don’t know today what impact this decision will have on public opinion, but there’s at least a possibility that it will cause some segment of the public to shift position. More importantly, though, as Frum raises in his last paragraph above, the Supreme Court’s decision today pulls away the last excuse that most anyone had to not prepare for the implementation of the law in less than two years. The closer we get to January 1st, 2014, the harder it will be to dismantle the structure that the law creates. Finally, American history since the New Deal Era shows us that repealing social welfare legislation is difficult if not impossible; it’s only happened once when a bipartisan coalition united to repeal a badly thought out Medicare prescription drug benefit program that had aroused considerable ire among the elderly population. For that reason alone, repealing something as massive as the PPACA, without offering a replacement, is not going to be easy at all.
Finally, even if the GOP does win the White House and the Senate in November, one has to wonder how eager they are going to be to make repealing the PPACA the central part of their first year in office. No matter how big an issue it becomes in the election, ObamaCare repeal is unlikely to become the most important issue for voters in November. The issues on the top of their list will be jobs and the economy just as they were in 2010. In fact, according to the 2010 Exit Polls, the issues of importance to the voters were as follows:
- The economy — 63%
- Health care — 18%
- Immigration — 8%
- War In Afghanistan — 7%
This was in an election year during which opposition to “ObamaCare” was a central part of the Republican campaign for Congress. Does anyone really think that health care, and specifically repeal of the PPACA, will be any more of a voter priority this year, especially in light of the state of the economy? More importantly, once they do get into office in January would Republican want to spend their time trying to repeal the health care law, or passing legislation that would help stimulate the economy and cut the budget deficit? These are open questions, I submit.
Of course, many on the right will respond by saying that repealing the PPACA is economy stimulus in and of itself because it removes burdens on small business. Even conceding this to be true, and I tend to agree with it, another massive burden on businesses is the rapidly increasing cost of health care. That also happens to be a huge part of the problems with the Federal Budget at the moment. What is the GOP going to propose to help bring those costs under control? I ask because there’s simply no rational argument in favor of returning to the pre March 2010 status quo. Unless we bring health care costs under control, the federal spending is going to continue to skyrocket and the deficit will continue to soar. Moreover, businesses will find it increasingly difficult to afford health insurance for their employees. So, even if you agree that ObamaCare is bad for business, you’ve got to come up with an alternative plan or we’re going to be dealing with the same problems we have today.
Mitt Romney stood today behind a placard that said “Repeal and Replace Obamacare,” but the repeal part won’t be easy at all and, so far, he hasn’t said a darn thing about the “replace” portion of that slogan. One would think he’ll need to fix that soon.
Update 6/29/2012: Further thoughts here.
Doug that picture of Romney is fantastic.
I certainly believe that they’ll hold a vote, at least in the House anyway, but I feel pretty confident that even they don’t remotely believe that they’ll achieve repeal.
Like more and more votes these days (which is, IMO, our largest problem), the intent isn’t to achieve a policy change. It’s to achieve a political end – namely being able to use the vote itself as an argument for displacing the opposition.
Am I the only person in this country who is sick to death of perpetual election campaigns?
Granted, he’s under pressure to show “leadership” (or something) by responding quickly, but this is one of those things where taking a few more hours to digest everything might have been a better idea.
I predict that the law will not be overturned and I dont even think they will hold a vote on it.
I do think they may tweak some aspects of the law-probably more minor and feel good.
Pretty much with this decision Obamacare and the mandate are here to stay and IMO within the next 10to 20 years will have proven unworkable and the next step from the government will be some kind of single payer or mixed private/government system that isn’t anything like what we have now or the ACA.
I think the most obvious question for Romney gets missed as well:
Why was this concept a good idea for Massachusetts, where it not only seems to be working well, but also seems to be exceedingly popular, but a bad idea for the country as a whole.
And the “states should handle this” argument he’ll respond with is useless as well, because the next question will undoubtedly be “a person’s access to healthcare should be dependent on where he/she lives? Is that what you are asserting, Governor Romney?”
It opens Romney up to being led to all manner of unhappy rhetorical bottomless pits leading into November.
Doug, to write that headline, you have to have not been paying much attention to the level of sheer hypocrisy and insanity the GOP has come out with to try and shout down the ACA.
They. Have. Nothing. To replace it with.
They. Want. Nothing. To replace it.
There has been no proposal from the Right on what to do about soaring healthcare costs since Romney came up with Obamacare back in Massachusetts. The official GOP position on dealing with the problem is, quite literally, “Get rich or die.”
Politically, the best thing for them to do now is to quietly start pretending it all never happened, but frothing looneys like Jim DeMint and Rand Paul won’t let that happen…
By 2040, the Republican Party will campaign on the promise that it won’t raise taxes to preserve the Affordable Care Act.
I just have to highlight some of the comments from the shining lights of the Republican Party here:
Yeah, only Rand Paul gets to decide what’s constitutional, bitches!
You see, if the people who pass laws are no longer in congress, those laws are invalidated. Also, time for a civil war, please.
Frothing Looney 1:
By 2040, the Republican Party will campaign on the promise that it won’t raise taxes to preserve the Affordable Care Act.
By 2040 there won’t be an ACA to defend. At that point it will have destroyed the private insurance and healthcare system to the point that there will likely be a single payer system or some version of one.
My opinion in general for ACA is that it is meant to make medical care worse in order to make it the stepping stone for what liberals really want-a single payer system.
Rep. Mike Pence (R-IN) reportedly compared the Supreme Court decision upholding President Obama’s health care law to the September 11 attacks at a closed door GOP meeting on Thursday, several sources tell Politico.
Ladies and gentlemen, the next governor of Indiana.
Mitt’s original objection was legal. He argued that it was OK for states but not for the federal government. Now the court says it’s OK for the federal government. That leave his state-good, federal-bad, argument pretty toothless. Poor Mitt. Recent polling had him trailing Obama on economic issues, and now this.
He really should, joking aside, have flipped. He should have said “if the Supreme Court is on board, so am I.”
What could the far right have done? Brought back Gingrich?
@Just Me: I don’t think ACA will make care worse but turn the insurance system into such an alphabet soup of programs and partnerships that single-payer will look great by comparison. Hopefully in less than 28 years.
The Republicans need to campaign long and hard on consumer driven health care, on taking the power away from the gigantic health insurance companies and HMOs (which are a government creation) and giving them back to patients. Dismantling this horrible health care shibboleth and instituting HSAs would be an incredible improvement.
Unfortunately, the Republicans went with Romney…and they have no plan to actually fix anything. Because, in the end, they don’t want to fix anything.
PS: Also, am I the only one who thinks Romney’s logo looks like an ad for toothpaste?
I’d say a regional real estate agnency.
This would work for younger people, but for the elderly, in general, it’s just not possible to pay for health care without an insurance plan.
God I hope so, why should every other OECD country have decent health care except us (yes even the british system is better and it’s the worst of the lot). Getting us to the single payer we should have had decades ago (and would have if not for the fanatical devotion by the right to long since disproven economic fallacies) would actually make the PPACA worthwhile.
@Jeremy: …HDAs won’t fix the inhumanity of perpetual pre-existing condition exclusions 🙁
They won’t even try because as usual the GOP has nothing better to offer.
This is just noise. It’s over. ObamaCare wins.
You might even be able to drop “Care” from that.
Romney needs a new pony to ride, if he’s going to win in November.
You kidding? In its current state, the GOP couldn’t even deliver a pizza.
They’ve voted on repeal several times, but nothing on replace yet. If they were serious about their ideas to replace they could have easily voted on those as well, so it’s obvious they are much more willing to act on repeal than replace.
This isn’t really a surprise, as the current GOP doesn’t do policy and doesn’t really have any health care ideas left.
Can anyone point me to an unbiased analysis of the healthcare industry, its pre-Obamacare costs broken down to key components, and then contrasted with the projected impact of Obamacare per item over 10 or more years, including the newly added cost items, of course?
I am supposing, perhaps wistfully, that by now someone or some group that is knowledgeable of the industry, with an objective mindset and little political bias, has actually read the entire bill and analyzed it’s impact in cost terms for the future, and also carefully set forth their assumptions about the key drivers of cost over time. The CBO makes some sorts of calculations, but their assumptions are given to them by the Congress with a political tilt.
@PJ: In Pence’s defense, he did give an immediate and genuine apology… Not one of those limp, “I’m sorry if anyone was offended” pieces of junk, but an actual “Oh crap, I went to far with that – my bad” apology. Political disagreements aside, I’ll give him credit for being big enough to say that.
That’s not how the CBO works, as Congress does write the laws, but the CBO does their own research rather than going off assumptions. So the CBO reports are probably exactly what you’re looking for.
As an aside, one of the reasons the GOP and Paul Ryan are mocked and called charlatans is because they provided the CBO with the assumptions for the tax revenue their “plans” will create instead of actually writing them out to be evaluated.
The Obama administration has managed to put us many more Trillions of dollars in debt, which somehow doesn’t surprise me since it has been a fully Democratic congress (up until 2010) and administration, and it appears that Obamacare will add to that total substantially, according to some pundits.
I would like to know the truth of the matter, if such exists.
Over the years I’ve heard many references to Indiana as the “North South”
If what you say is correct I thank you for the information.
My memory is that this issue of the politically-driven base assumptions given to the CBO by the legislature to be used for their calculations was a thoroughgoing critique of such CBO projections by The Heritage Foundation in about 2007 or 2008, I think, so it stuck in my memory. (I will have to search for a reference to satisfy myself about this.)
In any event, I would appreciate an independent assessment if such is available.
@HarvardLaw92: The decision creates one other headache for Romney — the issue of Mandate as Tax. Again, any other Republican could have easily gone after Obama for “raising taxes” with the healthcare plan. But Romney’s Gubernatorial reputation is in part based on not raising taxes… except for the Mass Healthcare Mandate, which is also a tax.
I thought Tyler Cowen outlined the Republican plan a day or so ago:
“We need to accept the principle that sometimes poor people will die just because they are poor.”
I just looked at the new projected 10-year costs from the CBO for Obamacare, which was $1.76 trillion, but the CBO left out the related costs for federal administration, and the impacts on H&HS, which were in the $10 to $20 billion ranges each. Another $5 billion has to be spent on the IRS. Oh well, what’s a few tens of billions of dollars more for the government?
The Republicans need to campaign long and hard on consumer driven health care, on taking the power away from the gigantic health insurance companies and HMOs (which are a government creation) and giving them back to patients
And find themselves not only bereft of millions of dollars in campaign contributions from that industry, but also the subject of a well funded attack campaign funded by the same?
We’ll sooner see people living on the Moon.
Truthfully, the right move for him here would have been to move on. There is no upside.
Well, considering that over at NRO they’re already calling this “ObamaTax”……
May all of the writers and editors at NRO need to find medical insurance under the old, pre-“ObamaCare” system and may all of them have pre-existing conditions. What they’re basically saying to a sizeable percentage of people in the US is Eff Off And Die.
Cowen’s line is pretty shocking. I’d hope that it could be ameliorated, “We need to accept the principle that sometimes poor people will die [a few days sooner] because they are poor.”
I’d like to think that truly life saving procedures, things that buy us a year or more, are within our ability to pay for all.
If we are 90, and are found to have a cancer, we might just get tea and opium. That’s fine. We’ll probably live about as long as the 90 year old rich man spending all he can anyway.
@mannning: The same report that listed the $1.76 trillion number, also said the reform would cut the deficit by $50 billion more than previously projected, so it should still help even if there are some other associated costs.
There is no alternative. If poor people can’t afford medical care, they will go without. Republicans treat medical care like any other consumer good. If people die, well, that’s just a function of the “market.”
No doubt, but I hope we have a better health plan by then.
The Republicans will repeal but not replace and the health care system will get even more broken and in the end we will have single payer.
Who cares. The Democrats win on ACA is just more proof that the Republicans are irrelevant to governance or policy in the U.S.
As I have said before, the liberals always get what they want no matter the law, no matter public opinion, and no matter the long term consequence. Conservatives should learn that there is nothing that they can do at either the ballot box or in the courts to affect public policy.
Conservatives jobs is just to told what they are told to do by the elites of the U.S.
Wait, you forgot to mention our Single Party Doom.
That the government is going to take over health care and the Supreme Court has just rubber stamped a huge new entitlement program should be very good evidence that the U.S. is headed to being a one party state.
The Republicans have been shown to be unable to affect policy at the ballot box, in the legislature, or in the courts. The Supreme Court has sent a clear message that the Democrats are always going to get what they want.
Anyone college student or 20 something who has an interest in politics should be able to realize that there is no future in politics for conservatives.
When the U.S. get single prayer, we also get a nationalized I.D. system and the government trying to control people more than it does now.
Also, how will progressives reconcile single payer withe their support of open borders and unlimited immigration.
Next thing you know, we’ll have to take off our shoes at airports.
Also, how will progressives reconcile single payer withe their support of open borders and unlimited immigration.
Pretty sure they won’t be able to.
Immigration policy is likely going to have to change to reflect how immigrants-legal and illegal will be covered in this system.
When the U.S. get single prayer
I don’t think that we’ll ever get single prayer in this country, although not for the lack of trying on the part of evangelicals.
(I know it was a typo. I just couldn’t resist, sorry.)
“Single prayer.” What unhappily married folks say.
Democracy is such a drag. In spite of all those obstacles how on earth did Republicans win 7 of the last 11 presidential elections, and most recently sweep the 2010 elections to take control of the House?
There is no particular reason why the ACA has to evolve, or devolve, if you prefer, to a single payer system.
There are many functioning mandate-based universal health care systems in the world. I live in one such country. They work pretty well, especially in terms of keeping costs down.
A key distinction is for-profit health insurance companies. They don’t exist outside the USA, and did not exist in the USA until relatively recently. Such thing as a non-mutual health insurance company was explicitly illegal as it was obviously a threat to the public good. States would not let you incorporate such a business, much less let one sell insurance contracts.
For-profit health insurance is an experiment that has failed. If the ACA can drive them out of the market by limiting their profits, all the better for the rest of us.
It is not a question of winning elections as much as having an effect on policy. People vote for Republicans and yet, taxes go up, spending goes up, the private sector shrinks, and the quality of life goes down. When you have a Republican Party voting for a Department of Homeland Security and expanding Medicare, it should be clear that conservatives have zero influence on politics, governance, or policy in the U.S.
Political scientists and wonks should begin to speculate what will happen to the U.S. without a conservative political party and where elections have no effect on governance.
So we will get a lot more government intervention to balance off the reduction in the national debt, but only if the projected savings appear in fact, and only if they are indeed used to pare down the national debt. I suggest that the savings will end up being far, far less than the CBO projects, and that the congress and the administration will find many other uses for any of the money supposedly saved than by paying down the debt. In the end we will be paying out more in interest on the debt than was possibly saved by Obamacare. This reminds me of the Clinton “peace dividend” that was spent twice over even before any actual savings were realized from the 30-odd% force reductions. The difference went to–the national debt!