Emboldened by their victory in the Midterms, many Republicans are calling for repeal of the Patient Protection and Affordable Care Act (PPACA). How likely is it that we’ll see changes any time soon? Probably not very. More cautious observers are expressing reservations about the prospect of any reversal in the near term.
Paul Ryan, R-Wisconsin, one of the Republican young guns, says, “You can’t fully replace this law until you have a new President and a better Senate. And that’s probably 2013, but that’s before the law fully kicks in on 2014.”
Michael Tanner, a senior fellow at the conservative Cato Institute, is more straightforward,”Repealing Obama care is just not going to happen while Obama is in office.”
In the meantime, expect the following events to play out over the next two years.
1. House Republicans will vote overwhelmingly to repeal Obama care, with modest Democratic support from those elected who opposed Obamacare.
2. Harry Reid, Senate Democratic leader, will refuse to bring the House repeal up for a Senate vote.
3. President Obama will insist, as he already has, that it is foolish to “relitigate” a law which he regards as set in legislative, historic, and ideological concrete.
4. They will call upon Kathleen Sibelius, Secretary of Health and Human Services, to explain why costs have risen sharply since passage and why so many insurers and businesses have dropped coverage.
5. They will summon Doctor Donald Berwick, Administrator for the Centers of Medicare and Medicaid Services, to explain his views and to justify why he should be reseated following his recess appointment.
6. They will seek to repeal the reform the provision calling for submitting of 1099 forms for every $600 of business expenditures – a possible item of compromise.
7. They will seek to repeal restraints on Flexible Savings Accounts and Health Savings Accounts.
8. They will try to defund the $10 billion required for hiring 13,500 IRS agents to enforce individual mandates and track those who are qualified to receive federal subsidies.
9. They will try to defund the $10 billion needed to carry out other mandates, such as state based health exchanges, and regulations calling for more expensive comprehensive one-size-fits-all
policies meeting federal standards.
10. They will discuss extending more waivers, such as the ones already granted to McDonalds and similar companies, who say they cannot afford Obamacare mandates.
11. They will push to expand and replace the existing $50 million demonstration projects scheduled for malpractice reform.
12. They will introduce their own incremental reform issues – shopping across state lines, offering tax deductions to those with individual coverage, malpractice reform, expanded health savings accounts.
These dozen things will serve as fodder for the 2012 Presidential election.
One party’s meat – victorious Republicans calling for incremental or total repeal – will be the other party’s poison – defeated Democrats defending popular aspects of the law and praying defenders will not be ousted as most were in 2010. Both positions will require skill, luck, and a favorable political climate to carry out.
The big question is: are Republicans repeating Obama’s mistake by concentrating on health care rather than the economy?
Richard L. Reece, MD, of Old Saybrook, Connecticut, blogs at Medinnovation and is author of two recent books, Obama, Doctors, and Health Reform and Innovation-Driven Health Care. He works closely with The Physicians Foundation, a 501-C3 organization representing 700,000 physicians in state medical societies that issues grants to physician organizations to improve care. He can be reached at firstname.lastname@example.org or 860-395-1501.