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Why repealing the health-care law will be difficult in two charts

By Ezra Klein

Health reformers were the first to experience the pain of getting specific: Their cause was popular, but their bill had its difficult parts, and as the media -- and the other side -- focused on those parts for months on end, their cause became less popular. Now, however, it looks to be the repealers' turn. A new poll from the Kaiser Family Foundation asked Americans how they felt about repeal. As other polls have shown, there's certainly appetite for a partial repeal, if not a full repeal:


But then you start asking about repealing specific provisions and, well, things become less popular in a hurry:


Everything from the subsidies to the increase in the Medicare tax is popular. The individual mandate isn't, and you might see the GOP focus on that, but tweaking the penalty there is a far cry from full repeal. Eventually, the GOP is going to stop being on the side of health-care repeal and find themselves on the side of allowing insurers to discriminate against the sick and seniors to fall into the doughnut hole, just as Democrats eventually found themselves on the side of the Cornhusker Kickback and $500 billion in Medicare cuts rather than health-care reform.

What will happen, David Frum predicts, is that the GOP will focus on the bill's unpopular elements but blink when it comes to repealing the legislation itself. "Republicans may gain political benefit," he writes, "but Democrats get the policy. In this exchange, it is the Democrats who gain the better end of the deal. Congressional majorities come and go. Entitlement programs last forever."

By Ezra Klein  | November 9, 2010; 11:27 AM ET
Categories:  Health Reform, Polls  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: Death by dichotomy
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well sure this makes sense.

I would like to pay ZERO taxes, receive unlimited services from government employees that work for free just to benefit me.

oh and i'd like a pony too while they're at it.

Posted by: visionbrkr | November 9, 2010 11:38 AM | Report abuse

Had the democrats passed a real health care bill like Medicare for everyone from the President on down, it would be in effect now and unstoppable.

Given this terrible bill the republicans will "try to repeal" forcing Obama to veto. Score for the republicans.

This attempt will bring out the same anger that the original bill brought out and the evil democrats will stop the repeal.

The republicans will take over in 2012 and have the house, senate and white house. They will love the power that this bill gives the federal government.

Posted by: justinterested | November 9, 2010 11:46 AM | Report abuse

The Health Care Industry did not fund all of those GOP candidates to see the personal mandate repealed. There's no way that sees the light of day.

Posted by: klautsack | November 9, 2010 11:47 AM | Report abuse

Reword the 'financial help' into 'welfare' and see how it polls. I'm genuinely curious.

You did cherry pick provisions pretty well, though.

Posted by: krazen1211 | November 9, 2010 11:50 AM | Report abuse

Reword the 'financial help' into 'welfare' and see how it polls. I'm genuinely curious.

You did cherry pick provisions pretty well, though.

Posted by: krazen1211 | November 9, 2010 11:50 AM | Report abuse


So what provisions would you like to see repealed?

Posted by: klautsack | November 9, 2010 11:51 AM | Report abuse

hey klautsack,

the "industry" as you call it just started to slightly favor republicans when the writing was on the wall for most everyone but Ezra who would win in 2010. What's your explanation for the donations given by them in 2006 and 2008 cycles leaning towards democrats? Was the "industry" gunning for a public option?

Posted by: visionbrkr | November 9, 2010 11:55 AM | Report abuse

The Republican Party of today is very out of touch with reality, and has startlingly little belief in logic, science, education, expertise, and just thinking -- that's elitist libral stuff. So, I wouldn't put by them just repealing only the individual mandate.

Ezra, how do you think it would play out if they did this -- and it was actually signed by a President Palin in 2012 (as I've said before, if the economy's bad enough BRISTOL Palin could get elected, and Sarah could certainly win the Republican primaries, as these are dominated by the hard core)? What would happen? Who would blink first in the ensuing crisis?

Posted by: RichardHSerlin | November 9, 2010 11:56 AM | Report abuse

visionbrkr -

Well, obviously, no. They weren't gunning for a public option. And it wasn't in the final bill. Duh.

Posted by: klautsack | November 9, 2010 12:00 PM | Report abuse

Better trolls, please!

I don't understand how any of this happens with the Dems in the Senate and Obama in the WH.

Posted by: AZProgressive | November 9, 2010 12:14 PM | Report abuse


see below for a good article on health industry donations to congress.

so you're one of the loonies that thinks that the public option was shot down because the health industry donated to congressional democrats? You're totally discounting the fact that the President's office all but admitted that they bargained that out early with hospitals not the health insurance industry?

Posted by: visionbrkr | November 9, 2010 12:14 PM | Report abuse

The pollsters should tell the people what each items COSTS, nation-wide and then see what their answers are.

Posted by: OrangeForces | November 9, 2010 12:19 PM | Report abuse

visionbrkr -

I guess I have a difficult time distinguishing between hospitals and the insurance industry. Both serve essentially the same function these days - deliver health services at a handsome profit. There's a reason the former steel building in Pittsburgh now says UPMC (University of Pittsburgh Medical Center) on it.

If the health care industry was open to the public option, it would be in there. Maybe Obama made some early deals with some sector of the health care industry combine, but he wouldn't have vetoed a bill that contained the public option.

Back to the issue at hand, though. The Republicans won't be repealing the mandate any time soon. That's not what they were sent there to do. Maybe they'll force some ostensibly embarrassing votes on it or on abortion or something, but overall they don't want the system changed all that dramatically.

Posted by: klautsack | November 9, 2010 12:37 PM | Report abuse

"So what provisions would you like to see repealed?"

Me personally? Just get rid of the extremely generous cash handout subsidies and I'll be happy.

You can punch stuff in a calculator here. A lot of income brackets are paying a whopping 5% of their premium.

That's freeloading.

Posted by: krazen1211 | November 9, 2010 12:48 PM | Report abuse

The only stuff that has a chance at repeal is stuff that takes money out of the hands of insurance companies, like the elimination of the Medicare Advantage subsidies. And given the public's sudden allergy to deficits, I don't see that happening.

Even as a strong supporter of the bill, now law, I'm not without some serious misgivings. There are some Republican ideas that could do a lot to lower health care costs and improve quality, like tort reform and more individual choice in the plans we purchase. There are some Democratic ideas like the Public Option that could do the same.

More realistically, I'd love to see the exchanges open up to all comers, with the possibility for states to roll their Medicaid systems into it as well. Big state-level bucks could be saved on overhead alone.

Sen. Wyden called Medicaid a caste system, and I wholeheartedly agree. I also agree with the now-deposed Republican counterpart, Bennett, that consumer choice like a well-run exchange might provide could do a lot to lower costs and improve quality. I'd love to be able to walk away from my crappy insurance company.

Point is, we could pass legislation to make this law a lot better if our leaders were serious about making good policy. Even the super-touchy individual mandate could be changed into a series of "strong incentives to participate" that would lead to near-universal coverage just as well as a tax penalty.

Republicans have painted themselves into a corner with their strategy of rote opposition. Democrats are afraid to open the door to real modifications.

In this climate, I could imagine a caucus of policy-minded leaders (in safe seats) developing a "reform the reform package," but everyone seems either too emboldened or intimidated by the nutty noise machine to do so.

Posted by: itstrue | November 9, 2010 12:51 PM | Report abuse

Republicans will (probably) settle for some small tweaks around the edges, but no major changes. They'll get rid of the small business filing bit, tweak the subsidies, and tweak the penalties, but that's about it. I think they're smart enough not to go after the individual mandate, but if they do they'll get hammered for how big a problem this would create and they'll have to back away from it fast. Nobody's crazy about the individual mandate, but it is integral to the law as a whole.

Posted by: MosBen | November 9, 2010 1:07 PM | Report abuse


So you'd be okay with having an individual mandate without having subsidies to pay for the insurance these people are required by law to have?

Posted by: klautsack | November 9, 2010 1:35 PM | Report abuse


"strong incentives to participate" are just another word for let people game the system even more than they already are. if you want to increase costs on those that keep and maintain coverage keep that thinking but when costs skyrocket for those that keep and maintain coverage we'll have that line of thinking to lay at lot of the blame at.

I'd also LOVE Wyden Bennett's plan and its a shame that Senator John "Raytheon" Kerry shot it down in the SFC meetings at 1 am last winter.

Posted by: visionbrkr | November 9, 2010 1:43 PM | Report abuse

The problem democrats are likely to face on this policy is that health insurance premiums are likely to go up a lot in the future. The GOP will blame Obamacare. The democrats will insist that, while premiums are going up, they would have gone up more without reform.

In other words, the same argument they made on the stimulus bill.

Posted by: ath17 | November 9, 2010 2:00 PM | Report abuse

visionbrkr, to be fair, though Wyden-Bennet's plan was loved by wonks, there was never really much real support for it in the Senate. Kerry may not have helped it, but nobody really fought for it. I'm a little fuzzy on the specifics at this point (though I remember that it phased out the employer tax deduction), but I seem to remember that I also thought it was the most interesting idea from the last round. But again, if 20 Senate Republicans had pledged their votes for Wyden-Bennet we'd have a law that looked a lot more like Wyden-Bennet.

Posted by: MosBen | November 9, 2010 2:04 PM | Report abuse

"So you'd be okay with having an individual mandate without having subsidies to pay for the insurance these people are required by law to have?"

The mandate is quite simple. You get insurance or you pay the penalty.

There's no logical reason for subsidies to change that.

Posted by: krazen1211 | November 9, 2010 2:08 PM | Report abuse

The Health Care law is here to stay. It is hightime us Democrats hit back. Those murderous Republicans think we are going to sit still for another assault upon the sick, the injured, and the medical practice. Their grumbling will be short but not sweet. Hang em all.

Posted by: mullarkeymichael | November 9, 2010 2:25 PM | Report abuse


"Strong incentives" in my thinking is making the public an offer they can't refuse.

Before he made his latest transformation into partisan hack, Gingrich (early '09) proposed that people who opt out post a $10,000 bond to cover uncompensated care and make up for their actuarial benefits as likely "young indestructables."

I've also heard of proposals for opt-outs being required to sign away their access to the exchange for 5 years, or sign away their right wipe away all medical debt under bankruptcy. In other words, threaten them with the prospect of being responsible for the actual costs of care.

Then there's the employer mandate, which Republicans instantly deep-sixed back when they actually wrote their own health care legislation and were serious about bipartisanship.

There are a number of alternatives to the tax penalty-driven individual mandate that are at least worth exploring.

The goal ought to be getting as near to universal coverage as possible. I think that goal doesn't have to run counter to giving people some sense of having a choice in the matter. It might be a dumb choice, but a lot of people demand dumb choices, dumb as they are.

Posted by: itstrue | November 9, 2010 2:28 PM | Report abuse

You forgot a few:

The law will substantially INCREASE the Medicare payroll tax on ALL Americans because Medicare payments will INCREASE, not decrease as suggested by HCR.

Agree Disagree

The law will result in the bankruptcy of several states who are unable to fund their portion of the obligation, OR the Federal government will have to bail them out.

Agree Disagree

The law will create insurance markets that much like "energy markets' and "MBS markets" in the past will be regulated by people who are making $100,000 a year or so, and who are expected to stay one step ahead of people making millions or even billions from these same markets.

Agree Disagree

Posted by: 54465446 | November 9, 2010 2:49 PM | Report abuse


agreed. as long as the incentive does not allow people to game the system and with current costs a $10k bond isn't nearly enough. You get that from a day's stay in the hospital. Personally i'm fine with the mandate and the penalty. I think it will work but may need to be tinkered to rise with medical inflation as we go.


I've gotta say i love Wyden-Bennett the more I think about it. For people like itstrue who seemingly despises his or her insurance it allows them to change without forcing them to change jobs. Employers could still keep and retain good employees by buying coverage on the exchange for a set rate based upon his or her demographics. Insurers would love it because it would take many paperwork issues out from under them now that their admin costs are being looked at much more stringently. I'm honestly having a hard time thinking who SHOULD be against it.

And agreed that Republicans that voted against it are idiots and more concerned with gaining power (which they just did so it worked) than actually fixing the system which is a major problem.

Posted by: visionbrkr | November 9, 2010 3:02 PM | Report abuse


also access to the exchange does not mean access to care. Remember insurers can still and will sell outside the exchanges. Also EMTALA rightfully gives access to care in ER's so a time delay wouldn't work and would (IMO) cause major problems.

I also believe in an employer mandate too. It should be a shared responsibility. Not too much to hamper employer innovation but not too little to stifle employee's ability to afford coverage. Again Wyden-Bennett makes a ton of sense here.

Posted by: visionbrkr | November 9, 2010 3:14 PM | Report abuse


Near as I can tell, the $10k bond would go towards hospital disproportionate share payments and uncompensated care funds.

In other words, I agree that it wouldn't work without the opt-out's risk being spread, since an inpatient hospital visit is easily upwards of $10k.

I don't have anything against the individual mandate myself, but I can understand why it's perhaps the most unpopular part of the legislation. I only mean to suggest that people can respond to incentives just as well as they can to penalties. In fact, the tax penalty is really just another incentive that was poorly named. You can opt to pay it, after all.

Re: Access, that's what I work on. EMTALA means that ERs will always be open to everyone, as they should be. Doesn't mean there aren't incentive structures already in place to reduce unnecessary/avoidable ER visits. Some hospitals implement a charge for care deemed "unnecessary." Community Health Centers and other providers routinely make agreements with hospitals to triage and transport, among other possibilities.

Regardless of the system, access is going to be the issue of the foreseeable future. There just aren't enough primary care providers out there to see everyone, and universal coverage (which is good) will only exacerbate the problem. Rural areas are headed towards a real crisis in this area, and while the ACA does some stuff around provider recruitment, community health center expansions, etc., it's just not going to be enough.

Access, and the affordability of the premiums we'll all be paying come 2014 are the two things I worry most about. I really hope our legislators can come together to take those on more robustly than they did the first time around. Seems highly unlikely, alas.

Posted by: itstrue | November 9, 2010 3:37 PM | Report abuse

The only question is who removes the terrible, unpopular mandate first - SCOTUS or Congress. Apologist centrist Dems better hope its Congress, because some say if SCOTUS does it they will have to repeal the whole bill since the mandate is supposedly central to the whole Rube Goldberg scheme.

Myself, as a real Democrat, I don't care which way it's done, either way we have to go back to square one and figure out how to end the unaffordable unsustainable employer-sponsored private insurance monopoly system.

Posted by: michaelh81 | November 9, 2010 4:38 PM | Report abuse

Of course you get this kind of polling when you fail to include the "replace" side of the argument. I don't recall anyone seeking to repeal Obama Care without replacing it with "something" or a variety of targeted individual improvements. Conducting a poll that only addresses repeal is simply misleading.

Repeal and Replace.

Posted by: KingstonJW | November 10, 2010 11:30 AM | Report abuse

No one has yet seen this healthcare scheme implemented. Once people see the horrible and inevitable bureaucratic snafus, the red tape that will cost lives, and the corruption that must attend such a wholesale transfer of wealth and benefits (human beings are not angels) repeal will grow in popularity. Healthcare will be what consumes the entire first term of this presidency, despite the fact that the economy, and even security issues, are more pressing than healthcare, to most Americans.

Posted by: truck1 | November 10, 2010 11:34 AM | Report abuse

KingstonJW: maybe if the people saying "repeal and replace" would say what they want to replace it with that question could be asked.

Posted by: toiletminded | November 10, 2010 11:39 AM | Report abuse

"No one has yet seen this healthcare scheme implemented. Once people see the horrible and inevitable bureaucratic snafus--"

truck1 has yet to see the horrible and inevitable rhinoceros that will horribly, inevitably land on his head as soon as he goes outside.

Posted by: pseudonymousinnc | November 10, 2010 5:32 PM | Report abuse

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