The recent election was, in the view of many, a popular mandate to reverse course on Obamacare and thwart it from centralizing American health care. A full repeal should be passed in the House ASAP. But it will be stopped cold in the Senate. But that’s okay, as that will increase unpopularity of the thwarters of the popular will, setting up 2012 nicely to be an election about repeal.
But much can still be done to prevent the law from being implemented as written, illustrated by a good piece by the CATO Institute’s Michael Tanner in the New York Post. Tanner sets out a pragmatic and methodical strategy. First, use the power of investigation and oversight to highlight Obamacare’s flaws. From “What Republicans Can–and Can’t–Do About Obamacare:
At the low end of the scale, Republicans should use their new investigatory powers to hold hearings and force officials like HHS Secretary Kathleen Sebelius to testify about the law. For example, since the law passed we have learned that health care spending will go up, not down as promised, and that millions of Americans will not be able to keep the insurance they have today…In addition, President Obama’s recess appointment of British-style rationing fan Donald Berwick as head of the Medicare and Medicaid systems expires with the new Congress. If Obama reappoints him, Republicans should use his hearings to explore how ObamaCare threatens the quality of American health care and access to it.
That would be fun. Berwick can serve another year, but after that, adios unless he is confirmed. The Democrats in the Senate refused to hold a hearing. They can’t do that again unless they want to see him gone.
Next, selectively repeal unpopular parts of Obamacare that the Senate might accept, and which could put the president on the spot:
For example, Democratic senators like North Dakota’s Kent Conrad have expressed concerns that the law’s new long-term care entitlement is “a fiscal time bomb.” Several Democrats have indicated a willingness to repeal the law’s requirement that even small businesses file a 1099 tax form for every vendor that they do $600 worth of business with. Even President Obama has indicated a willingness to revisit this provision.
Defunding is a real potential given that all money bills arise in the House:
Republicans in the House now control the power of the purse. They should refuse to fund implementation of the bill. For example, the IRS says it will need to hire as many as 13,500 additional IRS agents to administer the law’s unpopular individual mandate. Congress should refuse to appropriate the money to do so. All sorts of provisions could be subject to defunding. Theoretically, the House could go so far as to forbid HHS officials from spending any time working on any aspect of the law.
Cutting off funding risks having the Democrats shut down the government in an attempt to put public pressure on the Republicans to pass a budget with the health care funding that the president wants. President Clinton used this tactic successfully against the Republican Congress in 1996. But the public, as shown by this election, is in a very different mood now. And Obama is no Bill Clinton.
Finally, there needs to be a positive alternative:
Republicans should also start laying out their own positive alternatives. It’s not enough to simply repeal ObamaCare. Republicans will have to show that they have their own proposals for dealing with health care costs and the uninsured. They had a number of good ideas during the debate over reform, ranging from allowing the purchase of insurance across state lines to changing the tax treatment of individually owned insurance, but those ideas couldn’t get much of a hearing while the president controlled the agenda. Now they can.
In the meantime, I expect the courts to gut the law by overturning the individual purchase mandate, which will require a revisiting, in any event. So, one way or the other, I think the law will be dramatically revised before it ever takes effect.
November 7th, 2010 | 12:23 pm
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November 7th, 2010 | 3:14 pm
If “Obamacare” was dependent on the cuts to be “deficit reducing,”
could negating the cuts betray the electorate?
“The Centers for Medicare and Medicaid Services
has released the 2011 Medicare Physician Fee Schedule Final Rule,
which includes a 23 percent cut to Medicare physician fees…
…Congress delayed a scheduled pay cut of around 20 percent in June.
Rachel Fields
Beckers Hosptial Review, November 04, 2010
.
.
Did the delay of the June pay cut alter the “affordability”
of the Patient Protection and Affordable Care Act (PPACA),
and if so, who voted for both the initial legislation
and reverse the cuts making the law “affordable”?
.
.
“…The report from Medicare’s Office of the Actuary
…acknowledged that some of the cost-control measures in the [PPACA] bill
Medicare cuts, a tax on high-cost insurance
…could help reduce the rate of cost increases beyond 2020.
…the longer-term viability of the Medicare . . . reductions is doubtful.”
wrote Richard Foster, Medicare’s chief actuary”
Associated Press
.
.
Have the American people been lied to,
if the government passed a law that said X,
and those who voted for it did Y,
that made the “affordability” non-viable?
.
.
“…Neither the [the Patient Protection and Affordable Care Act (PPACA)] bill
…nor the accompanying reconciliation…
…addresses the flawed formula that dictates physician payments under Medicare
…a bill passed by the House in November would scrap the SGR altogether,
replacing it with a formula designed to ensure that doctors’ Medicare payments
reflect the true cost of delivering care.
Pricetag: $210 billion.
…it was that cost that caused Democrats,
who’d vowed both to keep their reform package below $1 trillion and to offset the entire tab
to strip the doc fix from the larger reform bills.”
The issue has left Democrats in a pickle:
…with voters already weary of deficit spending,
nor can they borrow another $210 billion to fund a permanent fix.”
Mike Lillis
Washington Independent
.
.
If Medicare Cuts
are what makes the recently passed Healthcare Legislation “deficit reducing”
abd the 23% cut is not enacted in December,
how could those who voted for the legislation be considered
not guilty of misleeding the electorate?
.
.
From an email from some supporting the elimination of the cut:
“Is the new healthcare law accounting dependent on the 23% payment reduction?
If the can is kicked down the road,
does the math in the healthcare legislation become not operable?”
George Hartzman
The answer:
“That is how the administration officials explained it to us…
…Their numbers are based on the law as it stands,
and it currently stands that the cuts will occur.
I think you know the answer to your last question.”
Lee Beadling
Managing Editor, Orthopedics Today
November 7th, 2010 | 4:31 pm
“The recent election was, in the view of many, a popular mandate to reverse course on Obamacare and thwart it from centralizing American health care.”
In fact, exit polls clearly demonstrated that few voters cared about the ACA. They care about jobs. They do not care about Republican deficits. They care about jobs. They do not care about global warming. They care about jobs. The Dems missed it and got pitched on their butts. It IS the economy, stupid.
The Republicans accept your flawed analysis at their own risk, but they were making noise on the Sunday shows that they have misread the tea leaves. We want results. We want policies that work. Two years of investigations, bluster and blather will do the Republicans no good. If all they have to show for their efforts is blockade of the ACA, the Republicans, and the American people are screwed.
Wesley J. Smith Reply:
November 7th, 2010 at 4:39 pm
With Obamacare you have a “cure” worse than the disease, and it will keep getting worse as the years come on. In any event, I think you’re whistling past the graveyard, Jeffrey, but blow a happy tune.
November 7th, 2010 | 6:04 pm
Not whistling past the graveyard as I fully expect the Repubs to spend the next 2 yrs holding investigations. They have no other strategy, [irrelevant reference to foreign policy issue deleted.]
Any luck finding evidence to support your claim about what the voters wanted?
There is no such thing as Obamacare, it’s a Repub talking point.
November 7th, 2010 | 11:00 pm
One wonders what that “positive alternative” might be, since the Republican opponents of health care reform have had the past two years to come up with one and have produced nothing except “repeal and defund.” Calling for lots of hearings will accomplish absolutely nothing of a constructive nature, and will simply label them obstructionists.
November 8th, 2010 | 8:09 am
Yes, the American people are most concerned about the economy stupid. However, I do believe a point of the article, and of the election results, is that the health care system is not a separate issue from the economy–representing, as it does, what? Something like 15% of it, and growing.
The economic aspects of the ACA have turned out to be a betrayal of the promises given by its advocates. Interestingly, the populace became opposed to it even before they knew the half of the harm that it will cause.
I believe the bottom line is this–the election was a rejection of the Obama policy of socialistic solutions to every problem in sight. The economy as a whole is the most visible “target” of this rejection. But recall that a bad economy is bad for individual economic sectors, of which health care is one of the largest and most risky. Thus, the rejection of Obamanomics is integral with the rejection of Obamacare.
There are other issues with Obamacare that aren’t purely economic, and they simply add to the fact that it is a terrible initiative which must be absolutely defeated.
The Republicans do have an alternate plan, available to those who wish to review it. Like medicine, however, economics will benefit from this first principle: “First, do no harm.” When great harm is threatened, and when that threat needs to be defeated before any true progress can be made, it is prudent and a “positive good” to set a first priority on repeal.
November 8th, 2010 | 8:54 am
Since the CBO analyses of the ACA describes deficit reductions of over $100 billion in the first decade and over $1 trillion in the second, how will the “repealers” plug that deficit hole? Let me guess… tax cuts for the wealthy to stimulate the economy leading to more revenues!
November 8th, 2010 | 3:53 pm
Joe D.: “The Republicans do have an alternate plan, available to those who wish to review it.”
Where, Joe?
All I’ve ever heard about from the Republicans were tax cuts and individual health savings accounts, neither of which will result in extending health coverage to the current uninsured, which was the primary reason for health care coverage reform.
Or do you think there was another reason? Or do you think that there was no need for reform?
November 8th, 2010 | 8:33 pm
[...] also railed against regulation and specifically called for Obamacare’s repeal, which also got thundering applause. She pointed out that Obamacare was a job killer, an unfunded [...]
November 8th, 2010 | 11:21 pm
Joe D.: “The Republicans do have an alternate plan, available to those who wish to review it.”
Where, Joe?
Look up:
Patient’s Choice Act HR2520
Health Care Freedom Act S.1324
Empowering Patients First Act HR.3400.IH
That these weren’t allowed the light of day in the prior regime doesn’t make them fictional or irrelevant.
Party of NO, indeed.
November 9th, 2010 | 7:47 am
Craig:
The Republican “contributions” to affordable health care would accomplish no reform at all. They would have no impact whatsoever on making coverage affordable for the poor, the unemployed or the marginally employed. Consider the bills you’ve cited:
HR 2520 – Patients’ Choice Act (Ron Paul’s bill): Let’s appoint a committee to study the problem, and while we’re at it let’s repeal Medicaid, CHIP (Children’s Health Insurance Program), and give the poor and marginally employed tax credits (although we’re always complaining that the poor don’t pay any taxes, so God only knows what good that would do).
S. 1324 – Health Care Freedom Act of 2009 (Jim DeMint’s bill): Let’s amend the Internal Revenue Code to allow a tax credit for qualified health insurance costs (there we go again with tax credits). Let’s allow a health savings account or an Archer medical savings account to be used to purchase a high deductible health plan — which works only if you’re employed and have enough discretionary income to afford funding one. Oh, and let’s study the problem some more by having the Secretary of HHS award block grants to states so that they can develop “innovative models that ensure affordable health insurance coverage for Americans with preexisting health conditions” (whatever that means).
HR.3400 Empowering Patients First Act (Tom Price’s bill): Let’s amend the Internal Revenue Code to allow a tax credit for qualified health insurance costs… (had enough yet?). Oh, and let’s make the laws of the state designated by a health insurance issuer (primary state) apply to individual health insurance coverage offered by that issuer in any other state (secondary state) in which he writes insurance — so that all health insurers can incorporate in a place that will give them the greatest advantages over their customers. Oh, and let’s prohibit the Secretary of HHS from using comparative effectiveness research to deny coverage of an item or service under a federal health care program (Comparative effectiveness research, as you know, provides information on the relative strengths and weakness of various medical interventions).
All these bills HAVE seen the light of day, since they all went into committee; however, given their worthlessness I think they’d be better off dying there. They epitomize the age-old Republican philosophy of “screw the poor.” Party of no? Not at all — at least not where the wealthy are concerned.
November 9th, 2010 | 9:17 pm
HW, thanks for doing the homework.
Craig, I’ll stand by my comments. All tax cuts, no expansion of coverage to uncovered individuals, most of which are working poor and their children. No pre-existing conditions. No high-risk pools. No nothing, frankly. Just more posturing so the Republicans can claim they were doing their jobs instead of obstructing progress.
If the Republicans were to admit their real position, which is that they are opposed to any meaningful form of health care reform whatsoever, well… Guess I won’t hold my breath on that one.
November 9th, 2010 | 10:17 pm
If by ‘homework’ you mean misrepresentation and omission (including supplementary grants for low-income families, risk pools, safety nets for those with pre-existing conditions), then I’m not sure thanks are in order. Did you not read the bills?
Summaries of the legislative acts mentioned are easy enough to find with a simple search, and I’ve no doubt that anyone interested can read for themselves.
take care,
CH
November 10th, 2010 | 10:19 pm
Craig:
All the cosmetology in the world can’t make a Republican “health care reform” bill less unattractive. I notice you haven’t bothered to address their proposing tax credits for people who don’t pay taxes, or health care spending accounts for subsistence-level wage earners. Time you stopped living in a dream world and realized that the Republican proposals would be laughable if they weren’t so pitifully cynical.
November 10th, 2010 | 11:46 pm
So you’re admitting you made up the stuff about the acts mentioned not addressing subsidies and grants for low-income families and special provisions for pre-existing conditions?
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