We’re not partisan at the National Center for Policy Analysis. We like good laws and dislike bad ones — regardless of which party enacts them. I believe we have been as hard on the Bush administration’s expansion of Medicare as we have been on the Obama administration’s new health law. That said, the hot topic of the moment is: What, if anything, can the congressional opponents do about the new health law? Here is my take.
Everyone expects the new Republican-controlled House of Representatives will vote to repeal ObamaCare. This move will probably be blocked in the Democrat-controlled Senate, however; and failing that, the president will use his veto pen to save the Democrats’ crown-jewel policy achievement.
Then what? As I explained at National Review Online recently, if President Obama is willing to open up the health care issue and get a sensible reform, everyone should cooperate. But if that doesn’t happen, I expect guerrilla warfare. Now it seems that Orrin Hatch agrees with me.
Every move you make Every single day Every vow you break Every word you say Every smile you fake Every game you play
Remember, the really important features of the law (mandates for individuals, fines for employers, subsidies for people entering health insurance exchanges) don’t kick in for several more years (in 2014). In the meantime, opponents don’t really lose very much if the best argument for voting for them in the 2012 election remains in place.
The health care reform bill is an albatross hanging around necks of the supporters. I suspect there are very few of them who want to cast an up-or-down vote on it again. And as long as it’s there (especially if it’s never really implemented), it will cost the supporters many congressional seats. Imagine that the start date keeps getting pushed back. Along the way, ObamaCare will be a big issue in every election. That scenario would be a nightmare for the supporters of ObamaCare.
There is precedent for this. Under the Balanced Budget Act of 1997, Medicare growth was supposed to be slowed by the gradual ratcheting down of payments made to doctors. Yet Congress has delayed these cuts for the last seven years. The so-called “doc fix” is always temporary, never permanent. The issue returns for doctors and for the American Medical Association every time we have an election.
Ideally, one hopes the two parties will work together to reform health care in a way that’s good for doctors and patients. And I would say the ball is in President Obama’s court. If he wants to open up the issue again, I suspect we can have sensible reform with bipartisan support. If not, there is a lot the opponents can do without the president’s cooperation.
They could begin by voting to repeal the most politically unpopular features of health care reform. That means no individual mandates, no individual or employer fines, and no regulations of the type that might cause McDonald’s to drop coverage for 30,000 low-wage employees and the 3M Corporation to drop coverage for all its retirees. If there is a budgetary cost for these measures, it can be paid for by pushing back what I am going to call O-Day. That’s the day (Jan. 1, 2014) when all the subsidies and mandates are supposed to kick in.
The supporters of ObamaCare will probably be able to block these moves, by either Senate filibuster or presidential veto. If they do, that will frame the issue for voters in 2012.
Then opponents could come to the rescue of senior citizens. If nothing is done, Medicare will have to reduce its payments to doctors by 25 percent on Jan. 1, 2011. In the succeeding years, reduced payments get really brutal.
According to Medicare’s Office of the Actuary, Medicare payments to doctors and hospitals will fall below Medicaid rates by the end of the decade. Think about what that means. Right now, Medicaid’s low rates make it difficult for low-income families to find any private-practice doctor who will see them. As alternatives, they often turn to community health centers and safety-net hospitals. Now imagine seniors having to do the same thing, but being pushed to the rear of the waiting lines, as even poor people (with their Medicaid cards) pay the doctors more than what Medicare will pay for the elderly.
The short-term goal of those who favor “repeal and replace” will probably be to push back the dates of these rate cuts by an election cycle or two. To pay for that action, they can try to push back O-Day as well. Just as the doc-fix problem gets postponed year after year, O-Day could be postponed again and again. If the supporters of ObamaCare resist, in each election the central issue will be: Do we want to put seniors on the ice floe in order to provide health insurance for young people?
Let’s hope Republicans and Democrats agree on Medicare reforms that will really control runaway entitlement spending. In the meantime, though, the goal of the opponents of the ObamaCare approach can be to cancel cuts that are never going to be made anyway and pay for the cancellation by delaying the implementation of ObamaCare.
What has created such a rich opportunity for the opponents of the health reform law is that the supporters hugely miscalculated in putting the health care reform bill together.
The main beneficiaries of the new law are 32 million to 34 million people who otherwise would have been uninsured. Another group of potential winners are those with preexisting conditions. Let’s generously estimate the entire group of beneficiaries at about 50 million people. That leaves about 250 million who are on the other side — expecting to lose more than they gain. Think about that. There are five losers for every winner under health care reform!
Even more interesting, the gainers are largely dispersed and disorganized. In fact, most of them do not even know who they are. Do you know if you will be uninsured four years from now? Few people do. The reason? Uninsurance is like unemployment: It affects people unpredictably for short periods of time. The health care reform bill promises to spend billions of dollars four years from now on people we can’t even identify today.
People who are going to pay for the reform, by contrast, are organized, focused and aware that they are in the target zone. If you work for a tanning salon, if you make wheelchairs, if you are a health insurance agent, etc., you may not know your exact burden, but you know that the law was not written for you. And seniors are politically focused and potentially organized.
A smart GOP cannot be the “party of no.” It will not merely exploit the weaknesses of ObamaCare. It will get firmly behind an approach to health care reform that its members will seriously be prepared to enact if the Democrats are willing. This would include a commitment to making health insurance portable, affordable and fair, and a willingness to solve our most important health care problems by removing perverse incentives, empowering individuals, and letting competition in a free marketplace control costs and improve the quality of care.
John C. Goodman is president and CEO of the National Center for Policy Analysis. The Wall Street Journal and the National Journal, among other publications, have called him the "Father of Health Savings Accounts," and the Media Research Center credits him, along with former Sen. Phil Gramm and columnist Bill Kristol with playing the pivotal role in the defeat of the Clinton Administration's plan to overhaul the U.S. health care system. He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system.
Dr. Goodman's health policy blog is the only right-of-center health care blog on the Internet. It is the only place where pro-free enterprise, private sector solutions to health care problems are routinely examined and debated by top health policy experts throughout the country-conservative, moderate and liberal.
