Health Care and the 2010 Midterms

The election has given us a Republican House and a still Democratic controlled Senate. But, instead of Democrats having the 60 Senators they had when health care was passed in December, they will have a slim majority in the new Congress of 53 seats when the two Independents who caucus with them are counted.

Exit polls clearly show an anti-health care law sentiment. Exit polls done for the AP found 48% of Tuesday’s voters want the new health care law repealed, 31% want it expanded, and 16% want it left as is.

Remember those swing Democratic House votes that were on the fence over the health care bill last March? Most who voted for it are out of work this morning—and all but 11 of the 34 of them who voted against it also went down to defeat. Why did even those who voted against the new health care law lose their jobs? Because of one vote they all had in common–they voted for Pelosi as Speaker.

The two most prominent Democrats who touted their yes votes in their campaigns for reelection—Wisconsin Senator Russ Feingold and North Dakota House Democrat Earl Pomeroy—lost.

So, does this mean there is an overwhelming tide running toward repeal of the law?

The election results are likely a prescription for gridlock. With an Obama veto and the Democrats still controlling the Senate by a slim margin, it will be difficult, if not impossible, to get a health care repeal bill passed in the next Congress.

I do expect the Republican House to pass a bill repealing the health care bill very early next year. Then it goes to a Senate run by Democratic Majority Leader Harry Reid—good luck with that!

More likely, what we saw in the mid-terms was the opening act toward the 2012 elections. Republicans will be blocked from any major repeal action by the Obama veto and the lack of a majority in the Senate and will use that to call for voters to finish the job by giving Republicans control of everything in 2012.

The biggest problem the Republicans have is a lack of an alternative health plan. Repeal and replace the existing law with what?

Without a doubt there is a strong anti-health care law sentiment running. And, it might be possible to scare up a bare majority in the Senate for partial repeal legislation that comes under budget rules requiring only 51 votes. With the Republicans ending up with 47 Senate seats, they might also be able to get the new West Virginia Senator, Joe Manchin, to vote with them. Democrat Ben Nelson of Nebraska can’t seem to figure out if he is a Republican or a Democrat, and maybe Independent Joe Lieberman of Connecticut could be another pick-up. They would still need at least one more Democratic vote to get to 51.

And, Obama would have to go along with the changes for them to become law.

But it would take 60 votes to repeal all of the law. And, 67 to sustain an Obama veto of any outright repeal law.

Changing the health care law with 51 votes will require Republicans to put something up that dealt only with budget items and made a compelling argument that it was a prudent change. Just trying to repeal the individual mandate (a budget item) but leaving in place the underwriting reforms (which would require 60 votes to repeal) would create lots of unintended consequences that could well scare away not only these swing votes but even more Republicans as well.

It is possible that Republicans could try to amend the new law’s insurance subsidies to look more like their tax credit proposals, for example. But even there they risk looking like they want to repeal employer-based health insurance and that would be a very tough sale.

Republicans might also try to restore the Medicare Advantage cuts. But to do that they would have to come up with about $150 billion to offset that cost in order to avoid just adding to the budget deficit.

So, the viability of any repeal effort, or any effort to pass major amendments, will require Republicans to put a plan on the table that is compelling. I have no idea what that is based upon what I have heard the candidates and the Republican leadership say during the campaign.

The new House majority will enable Republican House committee chairmen to harass the Obama administration’s regulators at HHS. We should expect lots of testy hearings, which would have more political value as Republicans try to build momentum toward 2012 than accomplish a lot the Senate, would pass.

I would have to believe that the Obama regulators are at least a bit chastened in the wake of the election. The final MLR rules are due out in the next few weeks and a number of state insurance commissioners have called for more flexibility in implementing them. Based upon what happened yesterday, will Sebelius grant that flexibility? One would think so.

Just as interesting will be the need to fix the Medicare physician payments by the end of November. It will cost about $17 billion to patch that problem for just 13 months. With the voters saying, “no more debt” just what is the “lame duck” Congress going to do about that? Add to that the small business “1099” problem that would also cost about $17 billion to fix before it becomes effective on January 1, 2011.

The election results were also good news for Republicans in the states where they picked up at least 10 new governors’ seats. In separate races for insurance commissioner, two went to opponents of the law while California elected a supporter.

These state races will affect just how aggressive the states are in establishing the insurance exchanges due to become available in 2014.

We could see Democrats and Republicans simply to agree to disagree over the new health care law–maybe even seeing appropriations, like the money needed to build the 2014 insurance exchanges, held up until the 2012 elections finally decide who will be in control in the lead-up to 2014.

For now, the election results add more uncertainty as we immediately begin the 2012 election campaign and everyone gets ready for the 2014 implementation of the bulk of the new health care law.

You know, one of the things we talked about on this blog, on the way to seeing this bill passed, was the sense that you can’t pass something as big as health care reform without a consensus of support for it. If you did, there would be a huge risk that it would not likely have the necessary support to be properly implemented or even sustained.

If a Republican “defunding” fight over appropriations leads to the two sides gridlocked and finally just agreeing to table implementation until after the 2012 elections, we might just see health care as the preeminent 2012 issue–a vote for Republicans meaning repeal it and a vote for Democrats meaning implement it.

So, what is it exactly we accomplished last March?

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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15 replies »

  1. I agree with Steve, however, I hope that if the bill gets repealed, there should be a replacement. Without a replacement, then what’s the reason of repealing it. It should be replaced with something better which would cater to the good of all citizens in the US.

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  3. While bipartisanship sounds good, both parties have now lost many of their moderates. Bennett lost his nomination, partially, for just having his name on a bill with a Democrat. The bill may get repealed, but we will not see a replacement if it does. Our historical pattern is that Democrats push for reform, emphasizing access. Republicans avoid reform, but do vote in pieces like Medicare Part D or the SGR. After the difficulties this time, I dont see Republicans willing to put in lots of time on health care.I really expect them to play chicken on Medicare for a while longer.

  4. It is bad legislation as a whole because it was written and voted into passage by one party, so scrap the piece of crap and start over as a bipartisan effort, which what the majority of voters, even if 50.01%, said last Tuesday.
    You know what I don’t get, why the voters kicked out a sizeable portion of “incumbents” in office less than ten years, and left the bastard entrenched hierarchy in place who really are the problem, the Pelosis, Franks, Boehners, and other Repugnacraps who just echo the same schmut year and out, and leave the pawns to be sacrificed, which the dumbass voters buy into hook, line, and sinker.
    Hey folks, if you want change, and mean it, in 2012, which is unfortunately a bit less than 2 years away, don’t vote ANYONE in office more than 12 years back. Then watch real reform and jockeying for leadership, knowing the electorate will kick your ass out when you just tow the party line that does not involve the American public. And by the way, the Independents are the majority party now, because neither Democraps or Repugnacants do not have a majority vote in this country, at best 35-40%. So, without us, the independent moderate voter, who ya gonna turn to, the other party?! Only the clueless and intoxicated ignorant would think so!
    I voted Repugnacant this election, not because I liked them or embraced their message, only that I found the intoxicated power hungry Democraps who just echoed the garbage of the Repuggo’s for 6 years earlier to be hypocritical and offensive. The best result? Maybe they will kill each other politically these next two years!!! Literally would not be an acceptable comment to forward, but hey, one can wish, can’t I?

  5. “But I could imagine that fighting about certain provisions may make the bill more popular than it is right now.”
    I’m sure the 25% of people on MA will love to lose their plan.
    I’m sure all the parents that couldn’t buy their kids individual coverage loved that.
    When Employers drop coverage and push their employees into Medicaid I’m sure they will love that.
    When employers are forced to buy more expensive plans in 2014, raise employee cost and cut benefits I’m sure employees will love that.
    Your right rbar not a fact anywhere to be found

  6. Obama regulators are at least a bit chastened in the wake of the election. The final MLR rules are due out in the next few weeks and a number of state insurance commissioners have called for more flexibility in implementing them.

  7. Dan M – No polling exit data showed that in the least. If anything, keeping all of the Bush tax cuts polled at 40% or less in every major exit poll.
    Spending, healthcare, and the deficit were all issues that the general voters who went to the polls were concerned about and generally voted against candidates who supported more of the above. Keeping all of the Bush tax cuts was not one of them and it is not an issue that has enjoyed 50% support at anytime in the past year among registered voters in any poll.

  8. Part of me hopes the SGR cuts go through. It should be great fun watching people not able to get doctors to care for them.

  9. It will be interesting to watch the first act in this drama, the SGR cut debate that has to happen ASAP. $15 – $17 billion in new cost if it is postponed 13 months. The AMA came out strong for a delay. Or, they could do nothing and see how the system reacts to real cost cutting in Medicare. What will the new House majority do?
    Some said the election proved Americans felt they are Taxed Enough Already. Funny thing when personal interest and reality collide with grandstanding and ideology.

  10. Superb and realistic analysis. A remote chance exists that the Supreme Court will strike down the individual mandate. Barring that, it seems likely, as Laszwewski suggests, that only the 2012 election will resolve the repeal-implementation issue.

  11. “Exit polls clearly show an anti-health care law sentiment. Exit polls done for the AP found 48% of Tuesday’s voters want the new health care law repealed, 31% want it expanded, and 16% want it left as is.”
    Do the exit polls really show an anti-health care sentiment? With 48% wanting the law repealed but 31%(expansion)+16%(left as is)= 47% for the legislation. Seems like a 50/50 split Robert. We’ll see what happens when Republicans try to eliminate mandate, repel preexisting, restore caps and get rid of subsidies, AND fix Medicare without making any cuts to payments or benefits. All this of course with tax cuts and deficit reduction.

  12. What about that other piece of conventional wisdom, namely that a lot of pieces of the reform poll very well? I have the inkling that the GOP has managed to create an anti-Obamacare mood that is devoid of facts, just that it is unaffordable an entitlement for the undeserving … based on the fact that many people are confused about simple health care facts. But I could imagine that fighting about certain provisions may make the bill more popular than it is right now.

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