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What will a GOP win mean for health-care reform?

The question is not whether Republicans want to repeal the health-care overhaul. They do. "We offer a plan to repeal and replace the government takeover of health care," reads the 2010 Republican Agenda.

The question is whether they'll succeed.

There, the crystal ball gets cloudier. It would be very difficult for them to win a repeal of the Patient Protection and Affordable Care Act. Even in the most optimistic of election scenarios - a world in which Republicans take both the House and the Senate - they almost certainly wouldn't have the votes to overwhelm a Democratic filibuster, much less overturn a presidential veto. The law, most likely, is here to stay.

But that doesn't mean Republicans are powerless. If they control even one chamber of Congress, then they'll have at least partial command over appropriations. And the health-care law needs appropriations. The bill specifically details about 115 of them, some of which are integral to implementation of the legislation. Moreover, Republicans could get even more creative, refusing, for instance, to allow the Department of Health and Human Services to spend staff time setting up the law.

As with full repeal, the GOP would need majorities they don't have to pass any appropriations bills that sabotage the legislation. But unlike with full repeal, where only passing a bill would affect the Affordable Care Act, Republicans can still make their mark by simply refusing to pass any appropriations that would fund the law. And they have more than enough votes to keep any alternatives from passing.

So what happens if Republicans won't pass any appropriations bills that fund the health-care law and President Obama won't sign any appropriations bills that don't? A government shutdown, of course. And there are reasons for both sides to fear that outcome.

Republicans remember Newt Gingrich shutting down the government in 1994 and losing the subsequent public-relations battle. His overreach in that effort broke the GOP's momentum.

Republicans are also aware that though the health-care overhaul is unpopular, its component parts are quite popular. Simply repealing the entire act sounds better than allowing insurers to discriminate against children with preexisting conditions, or bringing back the days of lifetime limits on coverage, or telling insurers they don't have to cover dependents up to age 26. Republicans, in fact, have already struggled with this, implying that repeal would not actually mean the end of the bill's popular provisions - even though they have not settled on a policy that would allow health-care reform to both exist and not exist at the same time.

Democrats, however, know that the health-care overhaul remains unpopular, the economy is grim, and there is no guarantee that Republicans would not fare better this time. There is also the danger of "zombie legislation": a bill that lives on but is strategically undermined so that it appears ineffective, says Henry Aaron, a senior fellow and health care policy analyst at the Brookings Institution.

Politicians of both parties are risk-averse, and the likeliest outcome is that this fight is effectively tabled - particularly if, as predicted, Democrats hold the Senate. Republicans might mount a mostly symbolic vote on repealing the bill, and they could make a show of holding up appropriations in exchange for some smaller compromises on provisions that Democrats won't fight to the death over.

But Republicans are more likely to try to persuade their base to take the longer view and see this battle as one that will really be decided in 2012. Then, they believe, Republicans will have a shot a the White House - anda president whose pen will be on their side.

By Ezra Klein  | November 2, 2010; 8:59 AM ET
Categories:  2010 Midterms, Health Reform  
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Comments

You've been listening to Mitch McConnell, right? He's convinced the only thing that went wrong in 1994 was that they didn't destroy Clinton first.

This is going to go to the mat.

Posted by: pj_camp | November 2, 2010 9:39 AM | Report abuse

But aren't those largely symbolic votes to repeal the PPACA important? Aren't they a particularly effective form of public relations, in that (a) repeal efforts are desired by the public, (b) the President (and potentially a Democrat-controlled Senate) can be branded as "obstructionist", and (c) any perceived benefits of the legislation remain?

The PPACA is indeed likely to become the sort of Zombie Legislation described by Aaron: the same was true of ERISA. However, the discussion and controversy around the PPACA is likely to continue to benefit its opponents for many years [decades] to come.

For the sake of argument, assume that the PPACA is destined to be unfunded Zombie Legislation. If arrogance wasn't an issue, the President would refrain from vetoing a repeal of the PPACA and would thereafter hammer his opponents for having no replacement plan. The good news for the GOP is that arrogance IS an issue: the President and his supporters are arrogant enough to block all efforts to repeal, repair, and replace the costly Zombie PPACA that only a handful of elitist Democrats consider an "accomplishment".

A similar situation arises if the Senate is equally divided. Ultimately, for the party of the Vice President to "win" consistently in an evenly divided Senate, the Vice President must first vote to elect a member of his opponent's party as Senate President Pro Tempore. It's interesting how sometimes a minor defeat leads to ultimate victory... and evenly-matched opponents should keep that fact in mind.

Posted by: rmgregory | November 2, 2010 9:41 AM | Report abuse

"What will a GOP win mean for health-care reform?"

That we get to keep all of the bad stuff, but none of the good stuff.

Are they excited about repealing Medicare Part D? No?

Nevertheless, I voted my straight Republican ticket this morning. Preparing to gloat.

Posted by: Kevin_Willis | November 2, 2010 9:49 AM | Report abuse

unfortunately this will give Dems an excuse as to why the PPACA will fail to control costs.

If people looked closely enough they'd see that high risk pools have been a mess from inception (at least those that are set up to date) as just one example to the problems with this.

I'd much rather Dems retain control and see this fail on its lack of merits.

Posted by: visionbrkr | November 2, 2010 9:56 AM | Report abuse

Hmm. You assume both that Democrats in the Senate would filibuster, and that President Obama would veto, bills they don't like. How quaint. What color is the sky on your planet, BTW?

Posted by: stonedone | November 2, 2010 10:05 AM | Report abuse

@Kevin Willis,

I've done the same. I'm sure MosBen has been out there canceling out my vote by voting for Jon Adler. Sadly its not a vote against Adler but rather a vote against Nancy Pelosi as speaker. I'm really going to miss her.

Here's wishing Ezra will do a post on her as a "going away" present to her.

Posted by: visionbrkr | November 2, 2010 10:07 AM | Report abuse

Not to be all hopey changey or anything, but there was room in the negotiations on health care reform for Republican involvement and there still is room for updates to health care reform. The essence of the bill is the new entitlement for health insurance, which is massively unpopular with Republicans and sure, that could be a fight, but imagine a bill repealing the mandate and replacing it with something less unpopular. This would tend to split health insurance interests from Republicans and should be fun. Imagine malpractice reform. In HCR, we already pool everyone's risks, so we've really changed the way we allocate the costs of medical mistakes already. You can imagine a repeal of CLASS, which under PAYGO increases the deficit, but under CUT-GO is not problem at all. There's room I think for non-zombie legislation, except at the end of it the President would still get the credit, which would of course not be acceptable.

Every specific plan I've seen for health care reform from anyone is closer in a ACA world than in a status quo world.

Posted by: windshouter | November 2, 2010 11:49 AM | Report abuse

Ezra:

I know you will never believe this but health care wasn't really the number one issue to most Americans, not at least until the Dems took 18 months feuding about it every single day.

Need proof, how about this:

CNN/Money poll from July 2008.

"The slumping U.S. economy has become the top issue on voters' minds, according to a new poll and that concern is likely to carry on up through election day."

Iraq was number two, and


"Accordingly, 77% of those polled felt gas prices were "extremely" or "very" important to their vote, making fuel costs the third most important issue for American voters"

Health Care isn't mentioned even once in the article.

Need more? How about this:

"Rock the Vote's latest poll of 18-29 year olds shows young voters are increasingly engaged in the upcoming presidential election, driven by concerns over the faltering economy and a sense that our country needs a new direction. Concern over the economy, while a top issue for young people since 2006, has intensified and is now the number one issue this election for nearly half (41%) of 18-29 year olds."

Need more?

How about a a USA Tday Gallup poll two weeks before the election among young voters (remember, these are the people LEAST likely to have health insurance, and so the ones who should worry more about it)

"A USA TODAY/MTV/Gallup Poll explores the attitudes of Americans18 to 29 toward the 2008 campaign:

A LOOK AT THE ISSUES

What are the most important issues in determining your vote?

Economy 46%

Iraq war 29%

Health care 16%

International issues 11%

Energy/gas prices 9%

Taxes 8%

Education 7%

Abortion 7%

Defense/Homeland Security 5%"


Hey, but what do I know? I only back up my arguments with facts!

Let's round it out with a last one. The is the first exit polling data from the Huffington Post, on election night (keep in mind that I'm using Dem leaning sources for my info, so as not to get involved in partisan thinking):


"The first exit polls for the 2008 election have been released -- not candidate poll numbers yet, but rather perceptions on particular issues -- and, as much as they can offer insight, the numbers look generally good for Obama.

On a national level, the key concern to most voters, far and away, was the economy, which 62 percent of respondents said was foremost on their mind. This is considered to be Obama's strength.

Iraq, once thought to be the chief issue of the election, was chosen by only 10 percent of voters are their primary concern. And among that subset of voters, Obama had a 2-1 lead.

Meanwhile, nine percent of voters said terrorism was the top issue -- one of McCain's few strong-suits -- the same number who listed health care."

See what I mean? It was beyond HUGE to say what a mistake the health care legislation was in the way it was done and the lack of a sound financial footing.

where are your facts?

Posted by: 54465446 | November 2, 2010 12:06 PM | Report abuse

The whole bill is bad, but the killer is that the government forces you to buy insurance. Does that mean you can buy minimal--catastrophic only--insurance, and pay the rest out of pocket. That'd be reasonable, wouldn't it? Sorry, Obamacare forbids that. What an abomination!

Posted by: fraudbust2011 | November 2, 2010 12:58 PM | Report abuse

Wishful thinking, Klein...wishful thinking..

Posted by: tshep21 | November 2, 2010 4:12 PM | Report abuse

JOURNOLIST. This man has no integrity or credibilty...nothing worth reading here(whatever he said). Sullied his families name and committed treason against his chosen profession...to defend freedom of the press. For this paper to publish his comments, tells you that the Washington Post continues to be complicit in his actions.

Posted by: jkptak | November 2, 2010 4:13 PM | Report abuse

Why do tinpot dictators like this ezra klein keep trumpeting failures? obamacare is hated by America - and klein wants to keep jamming it down people's throats.

2012 is coming up, klein... our eyes are on the prize... cause obamacare dies.

And as usual, you will never have a clue as to what is going on beyond Washington DC district limits.

Posted by: wilsan | November 2, 2010 4:21 PM | Report abuse

Keep on whistlin' past that ol' graveyard, Ez.

Posted by: buck41 | November 2, 2010 4:26 PM | Report abuse

The more the next two years are about health care reform, the worse Mitt Romney's chances are of getting the Republican nomination.

Posted by: Porchland | November 2, 2010 4:30 PM | Report abuse

I believe that if you are someone that despises the "health care"law and wants it either thrown out or thinned out,you need not worry. Americans views of this scam is not going to change,and liberals know this. I they don't do what the people want,their jobs will be history. Everyone seems to forget that "We The People"wield a pretty big sword.

Posted by: mcap52 | November 2, 2010 4:34 PM | Report abuse

Obamacare will not make it to 2012. Republicans will defund it until the Supreme Court strikes it down, on the basis that it requires the individual mandate that everyone despises, exceeding federal authority. Congress unprecedentedly claims that not participating in commerce which does not, by definition, cross state lines, is interstate commerce. Republicans know it is important to get this notion settled in court, or else federal power literally has no bounds. And "poof," this loathsome piece of tyranny will vanish, much like the Democratic House majority.

Posted by: INTJ | November 2, 2010 4:42 PM | Report abuse

The Obami are particularly fond of citing insurers who "discriminate against children with preexisting conditions." Gosh, that sounds really awful, but wait, what about other sorts of insurance.

Shouldn't life insurance companies be compelled to insure people who have already died?

Shouldn't fire insurance companies be compelled to insure buildings that have already burned to the ground?

How about auto insurance companies? Shouldn't they be forced to insure drivers after the collision has occurred?

I think most people, regardless of their political persuasion, can readily understand how preposterous these requirements would be. Writing new health insurance for a person who is already ill is no different. In each case, the probability of loss is 100 percent.

Posted by: Oracle3 | November 2, 2010 4:43 PM | Report abuse

The Courts are likely to do what Congressional Republicans cannot. I would venture that it's about 80% that the current US Supreme Court finds the individual mandate portion of the Obamacare statute unconstitutional. Even Democrats agree that without the mandate, the current law is worse than nothing, because it would essentially force insurance companies out of business (if insurers must accept all comers on a commnunity-rated rate scale, they will lose their shirts unless everyone is forced to buy insurance).

That's the point where it matters that the GOP will win big today. If the Dems had kept their majorities, you would have seen single-payer passed ("Well, we tried to keep private insurance, but there wasn't any way to force insurers to insure everyone without driving them out of business"). Instead, you will see the current law repealed and some form of "Wyden-Bennett" lite (call it "Wyden-Ryan") passed in its place. Obama will have little choice but to sign it and take credit for "fixing" what was wrong with the current bill ("American people, I heard you").

Posted by: mfdesquire | November 2, 2010 4:50 PM | Report abuse

Hey Juicebox Mafioso:

You still don't, and never will have a clue. Stick to bad mouthing Israel and get over the defeat of your party.

Posted by: crimsonride | November 2, 2010 5:03 PM | Report abuse

If Obama starts using the veto and people have to choose between Obama as President and Obamacare he isn't President after 2012. Period.

Posted by: pga301 | November 2, 2010 5:17 PM | Report abuse

Ezra spent too much time with his delusional Journolist gang members.

Here is how it is going to work.

A GOP House will pass repeal and a GOP senate will send it on to Obama. Obama will veto it.

The GOP will roll it up and use it to demonstrate how the Democrats are still ignoring the majority.

If Democrats control the senate, the GOP House will still pass repeal. Then they will simply target the Senate Democrats & Obama in 2012.

After the GOP dispatches Obama in 2012, they will pass the repeal.

Its going away, right along with the infamous Cap & Trade.

Bye-bye Dems!!

Posted by: get8329 | November 2, 2010 5:28 PM | Report abuse

Ezra spent too much time with his delusional Journolist gang members.

Here is how it is going to work.

A GOP House will pass repeal and a GOP senate will send it on to Obama. Obama will veto it.

The GOP will roll it up and use it to demonstrate how the Democrats are still ignoring the majority.

If Democrats control the senate, the GOP House will still pass repeal. Then they will simply target the Senate Democrats & Obama in 2012.

After the GOP dispatches Obama in 2012, they will pass the repeal.

Its going away, right along with the infamous Cap & Trade.

Bye-bye Dems!!

Posted by: get8329 | November 2, 2010 5:28 PM | Report abuse

Ezra spent too much time with his delusional Journolist gang members.

Here is how it is going to work.

A GOP House will pass repeal and a GOP senate will send it on to Obama. Obama will veto it.

The GOP will roll it up and use it to demonstrate how the Democrats are still ignoring the majority.

If Democrats control the senate, the GOP House will still pass repeal. Then they will simply target the Senate Democrats & Obama in 2012.

After the GOP dispatches Obama in 2012, they will pass the repeal.

Its going away, right along with the infamous Cap & Trade.

Bye-bye Dems!!

Posted by: get8329 | November 2, 2010 5:28 PM | Report abuse

Ezra spent too much time with his delusional Journolist gang members.

Here is how it is going to work.

A GOP House will pass repeal and a GOP senate will send it on to Obama. Obama will veto it.

The GOP will roll it up and use it to demonstrate how the Democrats are still ignoring the majority.

If Democrats control the senate, the GOP House will still pass repeal. Then they will simply target the Senate Democrats & Obama in 2012.

After the GOP dispatches Obama in 2012, they will pass the repeal.

Its going away, right along with the infamous Cap & Trade.

Bye-bye Dems!!

Posted by: get8329 | November 2, 2010 5:28 PM | Report abuse

The voters want it repealed. Perhaps Ezra's perspective was clouded by his participation with the Journolist gang.

A GOP House will pass repeal.

If a Democratic Senate fails to pass it, then the GOP will use it against them & Obama in 2012.

If the GOP controls both chambers, they will pass it & force Obama to veto it.

It will be used against the Democrats in 2012, either way.

Bye-bye Dems!!

Posted by: get8329 | November 2, 2010 5:34 PM | Report abuse

Progressive propagandists like Klein are already beginning to sound more comical even though the polls haven't closed. Ezra suggests that there are a lot of reasons why the health care act will survive. I don't suppose it bears repeating that repealing health care is probably the number one goal of mainstream Americans. The GOP is going to defund and starve it while forcing Obama to veto bills to repeal it. They will devote time over the next two years to investigating all of the bad acts otherwise and then get rid of Obama and repeal the act.

On the other hand, Ezra could be wrong even sooner. It may turn out that right-thinking Democrats will actually act in a bipartisan manner -- come on, it won't kill you and vote with their GOP colleagues to repeal the bill next year.

Posted by: gmonsen | November 2, 2010 5:38 PM | Report abuse

I wouldn't dismiss the legislative branch so completely.

Posted by: JohnInNewYork | November 2, 2010 5:49 PM | Report abuse

I wouldn't dismiss the judicial branch absolutely. All this is moot if they decide the mandate unconstitutional.

Posted by: JohnInNewYork | November 2, 2010 5:52 PM | Report abuse

Do all Republicans come here to vent?

There is no majority in the public to repeal the bill, however loud you shout.

And it is good policy: no useful health insurance system can survive without government regulation, and the bill improves that regulation a lot. (And no, it is no government takeover. BTW: "Hands off my Medicare, right?")

Republicans may try to defund it, and that will be a fight. We'll see.

Posted by: rosmerineurope | November 2, 2010 5:58 PM | Report abuse

oracle3 wrote:

"The Obami are particularly fond of citing insurers who "discriminate against children with preexisting conditions." Gosh, that sounds really awful, but wait, what about other sorts of insurance."

Though I am against the health care legislation in general, the stupidity of your post stands out, although not more than get8329.

Usually, this is a column where posters bring more substantial arguments than either of you. Try to elevate your game.

Posted by: 54465446 | November 2, 2010 6:12 PM | Report abuse

More liberal wishful thinking and spin as journOlism.

Still clutching the "YES WE CAN" button in one hand and going down with the ship I see.

Posted by: cwon1 | November 2, 2010 6:40 PM | Report abuse

Others have said it, but it bears repeating: the Supreme Court will hear the cases challenging the individual mandate (probably in 2012).

I think there is a better than 50% chance that the individual mandate will be struck down--the District Courts have all recognized that the government's action is unprecedented--the commerce clause has never been stretched this far. That is not to say the courts won't extend the commerce clause here, but it strikes me as an uphill battle.

If that happens, there is a strong likelihood that the ENTIRE BILL will also fall. There was no severability clause included in the legislation, and, even if that were not enough, the government has basically stipulated that without the individual mandate, the entire act will fail.

In sum, there is a significant chance that the judicial branch will find the individual mandate unconstitutional. Without the individual mandate, the whole package is unsustainable.

If we have to start anew at that point, Republicans may have an actual role in the process--that is what is important here, not doomed-to-fail frontal assaults in the next 6 months.

Posted by: Johnny_Lawrence | November 2, 2010 7:38 PM | Report abuse

Ezra is right that Obamacare won't be repealed, but for the wrong reasons. Even if the GOP got veto proof majorities in both houses, repeal still wouldn't happen, because it is a major part of the overriding fascist agenda. Obama is merely the best figurehead to advance that agenda, and it is actually what drives both major parties. This use of "Fascism" can be summed up as increasing the powers of big government and big business against the interests of the entrepreneuraial, working, and poor classes.
The other day on a supposedly conservative talk show, the host silenced someone who brought up abortion and illegal immigration, saying that that was not the issue today. In the same way, about five years from now, after the totlatitarian aspects of obamacare become obvious to all, the opinion leaders will take any discussion of it off the table, shedding crocadile tears about the fact that it is a done deal.
That is how the fascsist agenda advances, and the sooner we all get a grip on it, the sooner we might have a chance of stoping it.

Posted by: skedoosker | November 2, 2010 7:38 PM | Report abuse

Hey Ezra you little bow Journolist hack. It is not here to stay. I and millions are NOT going to pay for it. My father had to stand up for what is right at 20 in WW11. Hid did not fight so we can become a Marxist nation. I will stand up at my advanced age to try and keep what he fought for. You wimp you have no idea what hell Marxists like you will release of you keep pushing. Did I say you are a propagandist lying scum.

Posted by: harley2002 | November 2, 2010 9:19 PM | Report abuse

They will try their best to repeal Health Care and then come up with NOTHING to put into place and thus we will be left with the same terrible system that we have now along with RISING costs across the board.

Brilliant

Posted by: Bious | November 3, 2010 1:40 PM | Report abuse

Well EZ, you might want to reflect on the events that have taken place during the last 24 hours. The Democrats got their ass whipped and the fun has just begun. If they want to keep cramming illegal legislation down our throats then they will face defeat in November 2012. We are very very organized, financed, determined, fired up, and committed to vote every single progressive out of office.

Posted by: bretfox | November 3, 2010 3:40 PM | Report abuse

Another quick comment. We are not married to the Republicans either. They must do what they promised or they will face defeat as well. We will keep trying until we get people in office who will keep their word. We are tired of being lied to.

Posted by: bretfox | November 3, 2010 4:03 PM | Report abuse

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