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Can the GOP sell reform and repeal?

By Ezra Klein

Reason's Peter Suderman outlines the central dilemma facing Republican legislators who want to roll back health-care reform: They can probably find the votes to change some of the elements conservatives find most egregious, but if they do that, they're implicitly making peace with the bill's existence, which is going to offend the wing of the party that will accept nothing less than full repeal:

Congressional Republicans ran against the health care overhaul, which means they’ll have to pursue it somehow. We’ll probably see a symbolic vote to overturn it—perhaps several. But the most effective and practical way to contain the law between now and 2012 will probably be to go after single sections...The politics of the health care law are such that a few Democrats might be willing to join Republicans in taking out selected parts of the law. Sen. Max Baucus, who oversaw a lot of the early negotiations over the law, is already indicating that he may be open to making changes in the legislation. And Republicans are reportedly on the hunt for other potential Democratic allies.

The upside of a strategy like this is that it stands a chance to result in actual (if small) changes to the law. It’s a path toward opposing the legislation that doesn’t rely mostly on erecting procedural barriers, as defunding strategies and state-led efforts to block or slow implementation would. The downside, at least for those who’d like to scrap the law entirely, is that it could reduce the urgency to repeal the law. Relying on an ongoing series of small tweaks, especially bipartisan tweaks, risks implying that the law doesn’t eventually need to be full overturned.

I can't figure out how they get around this one.

By Ezra Klein  | November 16, 2010; 4:20 PM ET
Categories:  Health Reform  
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Never underestimate the spinelessness of Democratic congresspeople

Posted by: fuse | November 16, 2010 4:29 PM | Report abuse

I think it's very simple: the GOP holds the repeal floor vote, it fails, then they go ahead and start with the tinkering and roll-backs of the 1099s and other stuff. The repeal crowd is mollified because they tried but it's either blocked by moderate Republicans in the House--or if they do get a majority somehow the big, bad Democrats in the Senate never take it up.

Posted by: DareToNo | November 16, 2010 4:33 PM | Report abuse

"I can't figure out how they get around this one."

I can. "Look! Sharia!!"

Posted by: klautsack | November 16, 2010 4:40 PM | Report abuse

It's really simple. All that has to be done is the massive welfare subsidies in the bill removed.

The public does not like welfare. Reagan and Clinton showed that.

Posted by: krazen1211 | November 16, 2010 4:42 PM | Report abuse

krazen1211- But this isn't what the conservative hub-bub is about. The TP party is all about the mandate. That and "Look! Sharia!!"

Posted by: klautsack | November 16, 2010 4:59 PM | Report abuse

The Republican party doesn't worry constantly about "selling" its policies. It focuses on pushing its policies through and winning elections so they can push more of their policies through.

We saw how Republicans handle health care reform. They passed Medicare Part D, which is more expensive than Obamacare.

They didn't spend an entire year dragging out meetings and negotiations over the bill, letting the other side launch an unprecedented propaganda war against it.

There were no "town hall meetings." They rammed it through in the middle of the night, and quickly moved on to other issues.

Outright repeal of the ACA will probably require them to win the 2012 presidential election. They're going to spend the next two years focusing on that, rather than worrying about how focus groups in Peoria view "repeal and replace."

Posted by: dstr | November 16, 2010 5:53 PM | Report abuse

Rewrite history, of course!

Afterall, the individual mandate was a Republican idea! Look how much MA loves Romneycare!

We've always been at war with Eastasia....

Posted by: will12 | November 16, 2010 5:54 PM | Report abuse

I can't figure out how they get around a Senate controlled by Democrats and a guaranteed Obama veto.

At best, they Republicans would have to wait until 2013, which is the first possible time that they could control the House, Senate and White House.

By that time, the ACA will be 4 years old, largely in motion, probably more popular, in a better economy, and no longer front page news.

Posted by: Porchland | November 16, 2010 6:22 PM | Report abuse

Whatever happens to the health care law in the hands of the Republicans will be for a good end. I'd expect them to try everything possible to repeal it, and even starve it of funds when they realize they can't repeal it. I would also expect the people who will be affected by all their efforts to kill the bill to come up in arms next election cycle. If they think they can take away this promised land that people can already smell and get away with it, they have another think coming.

Posted by: ifeanyiugwumba | November 16, 2010 7:07 PM | Report abuse

The PPACA will fail of its own accord, so the whole repeal movement is unnecessary; however, it does seem necessary to make the failure occur during Obama's reign so that the failure is his and his alone.

At present, implementation of the PPACA forces the failure on to the next President's watch and history might not clearly remember who actually caused the debacle. One good strategy would be to step-up enforcement -- to force the PPACA ahead full steam.

Posted by: rmgregory | November 16, 2010 11:25 PM | Report abuse

Ezra, you're missing a key constraint--the health insurance lobby. AHIP really really wants to keep the mandate. After all, who doesn't want the government guaranteeing a captive market? So Republicans know that eliminating the mandate (which is clearly the bill's least popular feature) will cut into fundraising. And yes, you can have a guaranteed issue law without mandates, New York State has had one for years.

Its a fool's errand of course, the big problem is affordability. The Pre-existing Conditiion Insurance Plan is running absurdly lower enrollment numbers than HHS expected. People who need insurance (those pre-existing conditions and all that) can now buy guarantee-issued policies, but they can't afford the premiums, that the Administration is surprised by this is amusing in a sick way.

In a country whose GINI index is halfway reasonable, healthcare could be funded by either premiums or by taxes. But in this country, income inequality is slowly asphyxiating the premium-based model and the premium subsidies that begin a month before the 2014 Winter Olympics are clearly inadequate (I forgot it, do the policies require 8% of income to go to premiums and 9% to copayments or was it vice versa?).

There's no way to get from here to universal coverage without a tax-funded single payer system. Someday when the Democrats can manage to win the White House and both Houses of Congress, maybe they'll do something about it. But when was the last time that ever happened? Its more likely, really, that Republican interest groups eventually realize they'll go farther if they kick AHIP out of the sled and then a GOP president makes it happen.

Posted by: beowulf_ | November 17, 2010 12:57 AM | Report abuse

The next best thing to repealing it or significantly reforming it is to go through the motions, force a veto or a filibuster if possible, and remind the voters constantly for the next two years at exactly whose feet all the warts of Obamacare belongs.

It's just what the Democrats would do with Cap and Trade, except nobody cares that the Republicans killed it. They will care that the Democrats prevented the repeal or reform of Obamacare, however.

Posted by: bgmma50 | November 17, 2010 1:26 AM | Report abuse

You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check .If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!

Posted by: crawiford | November 17, 2010 5:25 AM | Report abuse

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