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Posted at 2:21 PM ET, 01/19/2011

Please repeal responsibly

By Ezra Klein

Austin Frakt examines what a repeal effort focused on deficit reduction would look like:

The ACA has provisions that are clearly in the spending category (Medicaid expansion, exchange subsidies), provisions that are clearly in the savings category (Medicare cuts), provisions that are clearly in the revenue category (taxes), and provisions that are in the experimental category (ACOs).

Thus, if I were to make a budget-based argument for repeal, I’d advocate a partial one. Kill the spending, keep the savings, keep the revenue, and probably keep the experimental. The experiments could have costs, but it is hard to argue that we don’t need to try new Medicare/Medicaid financing approaches. Maybe not all of the savings will materialize, but should we not try to save something in an otherwise fiscally unsustainable patchwork of federal/state health systems?

Two things to say here. First, the distance between what Frakt is proposing and what the Republicans are proposing is further evidence that the GOP's erratic and unreliable concern over the deficit just isn't on the level. It's there when convenient, gone when inconvenient.

Second, this goes to something important in the bill: It's a bargain. Deficit hawks got liberals to support all sorts of Medicare reforms and cost-control experiments and taxes that they'd have never accepted in normal times. You can easily imagine an independent board empowered to cut costs in Medicare being exactly the sort of thing that liberals fight with every fiber in their bodies. But lured by the promise of universal coverage, the liberals struck the deal. Without universal coverage, there is no deal. Republicans don't want the cost controls -- they've repeatedly singled them out for attack, and made a very conscious decision to attempt a fiscally irresponsible repeal bill -- and liberals don't want them without the coverage expansion. People who talk about these cuts and taxes and projects as "low-hanging fruit" that can be easily plucked by future deficit hawks are sadly misguided. Without coverage hawks (health hawks? life hawks?) in the coalition, you don't have enough votes.

By Ezra Klein  | January 19, 2011; 2:21 PM ET
Categories:  Health Reform  
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Comments

Ezra says: "[concern with the deficit] is there when convenient, gone when inconvenient."

Kind of sounds like Ezra, who marches right along perpetuating myths about the ACA....even though his own post before lunch ('The first 12 million...') inadvertently gave rise to opponents being able to blast even more giant holes in the hull of the sinking ship that is his talking point "ACA = deficit reduction".

Posted by: dbw1 | January 19, 2011 3:36 PM | Report abuse

"Deficit hawks got liberals to support all sorts of Medicare reforms and cost-control experiments and taxes that they'd have never accepted in normal times. "

Wait, liberals don't actually support cost control 'experiments'? Who knew!

If you want to make your precious bill better, reducing the Medicaid expansion, exchange subsidies to $0.00 is the perfect way to do it. In fact, a 2 line statute.


1. All expenditures authorized for Medicaid for the PPACA are unauthorized.
2. Money saved in section 1 cannot be allocated to any other purpose.

Sounds like a great bill to me.

Posted by: krazen1211 | January 19, 2011 3:44 PM | Report abuse

Ezra, I noticed that you use the terms "Republicans" and "liberals". You don't use the terms "conservatives" or "Democrats". What gives? Your thoughts are valid, but your asymmetric language is making you look biased.

Posted by: walla151 | January 19, 2011 3:54 PM | Report abuse

@dbw

The raw absurdity of that statement is so funny.

The Democrats should have to choose. Are they health hawks, life hawks, or deficit hawks?

Posted by: krazen1211 | January 19, 2011 3:58 PM | Report abuse

walla151: He used "Republicans" where he meant "Republicans", and "liberals" where he meant "liberals". Specifically, the bargain to which he is referring is not in between Republicans and liberals, but between deficit hawks within the Democratic Party and liberals within the Democratic Party. Thus, it would be improper to generalize from "liberals" to "Democrats". On the other hand, Republicans as a whole have taken a party-wide stance against the cost control measures of the bill, not just the conservative Republicans. Moderate Republicans such as Snowe and Brown who could not rightfully be called conservative voted against it and spoke out against the newly raised revenue and spending cuts.

Posted by: snaxattack | January 19, 2011 4:08 PM | Report abuse

"But lured by the promise of universal coverage, the liberals struck the deal. Without universal coverage, there is no deal." That "is" should be a "was": the liberal group which favored universal coverage -- universal coverage made impossible by the lack of money and the lack of caregivers -- is a group no longer necessary for any sort of deal.

In the House, a solid elected majority exists and that duly elected majority has no real need to deal with any fringe elements. Since the Senate hasn't yet completed its first legislative day, things are relatively easy there, too: there are 47 solid votes and 4 probable votes, giving the 51 votes necessary to pass a day-one measure or a reconciliation measure. The fact that Republicans are welcoming compromise offers a degree of face-saving to potential obstructionists, who'd do well to grab the low-hanging fruit.

Posted by: rmgregory | January 19, 2011 4:12 PM | Report abuse

Oddly enough, if the republicans were to offer a partial repeal, taxes and medicare cuts are two of the least likely things they would keep.

Their partial repeal bill would probably include removing the individual mandate, reversing the cuts in medicare, and eliminating all of the new taxes while keeping all of the subsidies for individuals and small businesses. Their track record of voting (Medicare part D) and rhetoric (vow to have no new taxes) make that fact apparent.

It will be interesting to see if they start proposing individual elements to repeal. Will they propose anything about the medicare cuts?

I would guess the medicare cuts are important for the elderly voters who put Republicans in control of the house, but that would add $500 billion to the deficit and the Tea Party would not be too happy about that.

I am still trying to figure out how they were able to get voted into control of the house by people who should want the cuts in medicare (tea party) and the people who dont want the cuts in medicare (elderly). Both groups seemed to be convinced the Republicans could simultaneously reverse the cuts in medicare and reduce government spending.

Posted by: DeanofProgress | January 19, 2011 4:55 PM | Report abuse

Got everyone on record now ... Boehner's not stupid ... next up is restoring the 500B in Medicare cuts, killing the IPAB and trashing the individual mandate ... all of which are about as popular as leprosy ... and the albatross just gets heavier ... and heavier ... keep up the cheerleading dude you're doin' a great job as a man once said ...

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