Republicans won a smashing victory in this month’s U.S. national elections; no issue resonated more with the party’s base than President Barack Obama’s health-care legislation.
The House Republicans’ “Pledge to America” vowed “to repeal and replace the government takeover of health care with common sense solutions focused on lowering costs and protecting American jobs.” The party won more than five dozen seats, the most in seven decades.
There is no chance this pledge will be achieved.
While Republicans have a big majority in the House, Democratic control of the Senate and the presidential veto power make repeal or major change impossible.
There is another reason.
More than a few Republicans know that while the politics of trying to nitpick provisions and curb funding are appealing, any wholesale repeal of major provisions of the health-care overhaul would likely generate a backlash.
Even the Republican-leaning electorate on Nov. 2 was evenly split on repealing Obamacare, the exit polls showed. And many of the major provisions of the bill command broad support or could expose critics and repeal advocates to embarrassing contradictions.
One such provision is the enhanced Medicare prescription-drug benefit. It was in 2003, under President George W. Bush, that Medicare was expanded to cover drugs -- a measure backed by most congressional Republicans, who chose not to pay for these new benefits.
The Obama health-care bill expands and funds this coverage to cover a gap in payouts, or close the so-called donut hole. Under this provision, senior citizens currently affected by the gap next year will get, on average, an additional $553 of benefits.
Seniors voted 58 percent to 39 percent for Republican candidates in the midterm elections. Whatever the merits, there’s little clamor within the party to reopen the donut hole.
Medicare poses a larger quandary. A central critique of the Democrats’ health-care bill was that it would cut back on that program.
The Senate Republican leader, Mitch McConnell of Kentucky, accused Democrats of trying to “raid” Medicare. The Republican political group, Crossroads GPS, funded by anonymous contributors, ran attack ads against Pennsylvania’s Democratic Senate candidate, Joe Sestak, charging he “voted to gut Medicare -- a $500 billion cut.”
Checks and Balances
Representative Sestak, who lost a close Senate race, supported the health-care overhaul, which seeks to temper the explosion of health-care costs through greater efficiencies and checks and balances. Whether effective or not, it’s not a half-trillion-dollar cut in Medicare benefits.
Yet when it comes to reducing federal spending and budget deficits, a Republican priority, there’s no more important target than health-care spending in general, and Medicare in particular. The proposal by Republican Congressman Paul Ryan of Wisconsin to turn Medicare into a voucher system is designed to hold down costs. The catalyst for the 1995 government shutdown was the Republicans’ attempt to foist deep Medicare cutbacks on President Bill Clinton; it was a political disaster for them.
The reaction to the recent proposal by Erskine Bowles and Alan Simpson, the co-chairmen of Obama’s deficit-reduction commission, was instructive. They offered a plan that would take the deficit down to 2.2 percent of gross domestic product in 2015, from 9 percent today.
It includes almost $100 billion of tax increases that year, which leading congressional Republicans say is unacceptable, though they embrace the objective. To achieve such a goal without new revenue almost certainly would require slashing health-care spending.
The other principal Republican objection to the health-care bill is the individual mandate requiring Americans to buy health insurance or pay a penalty. That has been denounced by critics as bad policy. Some have even charged it is unconstitutional, or as Republican South Carolina Senator Jim DeMint put it, “inconsistent” with “the freedoms our Founding Fathers hoped to protect.”
Simultaneously, many critics say that one provision they would keep is the bill’s ban on denying health-insurance coverage because of pre-existing conditions. That can be done, Ryan and others say, by expanding high-risk pools in states to cover those people, disproportionately those with disabilities.
Except it never works that way. These high-risk pools aren’t adequately funded, there are cumbersome regulations to join them and, with fiscal situations tight in the years ahead, it’s a safe bet that those with the most clout won’t be people with disabilities.
To be sure, there are problems that could lend themselves to a bipartisan fix. Small businesses complain of too much red tape, some of which can be alleviated. Some Democrats even want to allow states to opt out of the individual mandate, though that would create enormous complications.
Still, many of the horror stories that critics contend the bill already has produced, upon closer examination, are distorted or simply wrong. When several Catholic hospitals in Scranton, Pennsylvania, announced earlier this year that they were closing, Republicans immediately charged it was due to the onerousness of Obamacare. It sounded persuasive, until the director said the hospitals had been in economic trouble for two decades, and the health-care bill had little to do with the closures.
Almost none of the stakeholders who supported the health-care bill -- hospital associations, drug companies, some physicians groups and even many insurers -- favor repeal.
What some would like is to gut a provision that establishes an Independent Payment Advisory Board, which would be charged with curbing spiraling costs in the future. Everybody is for “bending the cost curve” of the most expensive health-care system in the world until it comes to actually cutting costs. That transcends party and philosophy.
Most of the health-care moves in the 112th Congress will be more games and pandering to a hardcore base; charges of socialism will reverberate, just as they did when Medicare was enacted in 1965. Never mind that under Obamacare there is less government involvement in the health-care system than in most countries.
The Republicans’ real agenda is to continue the drumbeat of criticism until Obama is defeated in 2012 or, what many privately say is a more realistic hope, a Republican-dominated Supreme Court rejects the measure.
(Albert R. Hunt is the executive editor for Washington at Bloomberg News. The opinions expressed are his own.)