Why Do Republicans Continue to Try to Repeal Reform? (A Method to Their Madness)

(A longer version of this post originally appeared on Healthinsurance.org  There, you will also find a link to an HIO post showing how each Representative voted—and who didn’t vote.)

Last week the House voted—for the 37th time—to repeal the Affordable Care Act. Everyone knows that repeal will never pass the Senate.  Some suggest that legislators might better spend their time (and our tax dollars) figuring out how to create jobs.

Even the Congressional Budget Office (CBO) couldn’t take this 37th vote seriously. When preparing for this latest showdown, Republican Paul Ryan requested an update to CBO’s July 2012 estimate that repealing the ACA would cost more than it would save, increasing the deficit by some $109 billion over the coming decade (2013-2022.)

CBO replied to his request: “Preparing a new estimate of the budgetary impact of repealing the Affordable Care Act would take considerable time – probably several weeks – for CBO and the staff of the Joint Committee on Taxation, because there are hundreds of provisions in the ACA and those provisions are already in various stages of implementation. . .   We have just finished the time-consuming task of updating our baseline budget projections and need to finish our analysis of the President’s budgetary proposals.”

I like economist Jared Bernstein’s paraphrase of CBO’s response: “You guys go ahead and keep gettin’ your crazy on … over here we’re kinda busy doin’ actual work, so can’t help you right now.”

CBO added that when it does have time to do an update, it expects similar results. Repealing health care reform would add to the deficit.

                              Are Republicans Crazy . . .  Or Cunning?

You might think that by continuing to obsess over a bill that will never succeed, Republicans are once again exhibiting their self-destructive tendencies. But I would argue that House Republican leaders are not crazy, at least not in a way that is easy to understand. They’re cunning.

Ask yourself this: How many people skimmed or half-heard the news stories telling them that the House had passed a bill to repeal Obamacare?

This helps to explain why 12 percent of all Americans believe that the ACA already has been scrubbed. Every time a commentator mentions “health care reform” and “repeal” in the same sentence, the words will sink into that morass of half-truths and fictions that we call “the conventional wisdom.”

Even if people realize that the ACA  is now the law of the land, many take the repeated efforts to kill reform as a sign that there is something very wrong with the legislation.

After all, they think: “why would Republicans spend so much time trying to overturn a law if there wasn’t something terribly wrong with it?”

Of course House Republicans also voted against re-authorizing the Violence Against Women Act.  (Until it became crystal clear that they were once again tossing the women’s vote under the bus.)  Then there was the time when they voted unanimously to support an anti-abortion bill that redefines rape as “coercive” (as opposed to voluntary rape?)  GOP solidarity is not necessarily a sign of clear thinking.

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A Centrist Perspective: Makers and Takers, Obamacare, and the Path Forward

Below, a guest post from Stephen Reid, Managing Partner at Pharmspective, a market research firm that provides advisory services to healthcare and pharmaceutical companies on strategic issues including the Affordable Care Act. (ACA)

I don’t  agree with Reid on every point. (For example, if Republicans take both the White House and the Senate, I believe that they could and would eliminate both the premium subsidies that will make insurance affordable for middle-class Americans and the mandate.) Nevertheless, when he sent his Op-ed to me I was impressed by how well he understands the legislation. A great many moderates have been confused by the arguments coming at them both from the left and from the right.  A combination of misinformation, half-truths and fear-mongering has created so much “noise” that it has become extremely difficult to separate fact from fiction.

By contrast, Reid does a very good  job of explaining the reasoning behind the Affordable Care Act, and how its “checks and balances” work. I agree with him that the legislation is far from perfect, but it represents a good beginning.

 There is just one major aspect of reform that I think Reid doesn’t understand: the rationale for expanding Medicaid. See my note at the end of his post.

                   A Centrist Perspective: Makers, Takers and Obamacare

by Stephen Reid

With a few days left before we elect a president, the prevailing belief is that an Obama win would propel the Affordable Care Act (ACA) forward with little delay and a Romney win would kill it. Both parties have gone to great lengths to characterize healthcare reform; the Democrats tout the legislation as essential to addressing a broken healthcare system that results in the U.S. spending twice as much as most developed countries on healthcare while leaving 50 million people without coverage; the Republicans cite the ACA as an example of hopeless dependency on government and contrary to free-market principles and individual rights.

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Could President Romney repeal Obamacare? No.

 Mitt Romney’s web site makes a bold promise: “On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all 50 states. He will then work with Congress to repeal the full legislation as quickly as possible.”

Many of Romney’s supporters assume that this is what will happen if he wins. But in truth, even if Republicans take both the White House and the Senate, Romney wouldn’t have the power to “repeal the full legislation.” Nor could a new president grant waivers that would let states ignore the Affordable Care Act (ACA). We live in a nation ruled by law, not magic wands.

That said, those who support reform should keep a close eye on the Massachusetts Senate race, where Democrat Elizabeth Warren is challenging Republican Senator Scott Brown. The outcome could determine whether Democrats continue to hold 53 seats out of 100. (Political analysts rate Brown and Nevada’s Dean Heller as the two most vulnerable Senate Republican incumbents. If Republicans win the Senate, they won’t be able dismantle reform, but they could do serious damage to the ACA, by eliminating the subsidies that will help middle-class and low-income Americans purchase insurance. But even if they take over the Senate they will not be able to change the new rules for insurance companies.

                                    Romney’s Promises – and Why You Can’t Believe them

Begin with the “Obamacare waivers” for the states.

“There are no ‘Obamacare waivers’ that could be issued by executive order,” Washington & Lee health law scholar Timothy Jost explained in a recent phone interview. That’s right: these waivers simply don’t exist. Here, we’re tripping over one of those “Big Lies” that have become a feature of the Romney campaign. (Nazi propaganda chief Joseph Goebbels was the master of the tactic: if you tell a colossal lie, and repeat it often enough, people will believe it, not matter how outrageous. After all, who would make up such a whopper?)

On the HealthAffairs BlogJost elaborates :

You will find the rest of this post on HealthInsurance.org If you like, you can return here to comment.

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