A conservative group of healthcare analysts today welcomed the intention of the new House Republican majority to immediately pass a bill repealing President Obama’s health reform law. After that’s done, though, the analysts suggested the Republican leaders get to work on a more realistic strategy to destroy the president’s signature piece of legislature.
The panel, which was assembled by The Hudson Institute, a conservative Washington think tank, agreed that a House vote to repeal would be merely symbolic. A repeal is unlikely to go anywhere in the still Democratic-controlled Senate and would certainly face a presidential veto.
Still, the panelists seemed to think repeal in the House is more than an empty gesture. In the words of James Capretta, a Fellow at the Ethics and Public Policy Center and former staff member in the Senate and in the Office of Management and Budget , a House passage of repeal would “lay down a marker about where the new House majority stands, and it sends a signal to the people that put them in power that they’re going to keep faith with them in terms of their priorities. It really needs to happen.”
But, to Capretta, and the others on the panel, the real, renewed pitched battle over healthcare is not likely to happen until 2012, when, he hoped, a Republican presidential candidate would champion a comprehensive, market-based replacement of Obama’s reforms.
And, of course, that candidate would have to win.
The other panelists, Doug Badger, Partner in the Nickles Group and former deputy assistant to President George W. Bush for legislative affairs; Thomas P. Miller, Resident Fellow, American Enterprise Institute and former economist with the Joint Economic Committee; Nina Owcharenko, former Senate health staffer and Director, health policy studies, Heritage Foundation; and Tevi Troy, Hudson Institute Visiting Senior Fellow and former deputy secretary of the U.S. Department of Health and Human Services, agreed that the real action will probably occur after the 2012 elections. But, none of them advised the Republican majority to sit on its hands when it comes to health care.
What can Republicans do now? Troy, for example, recommended Republicans wage what he described as a “guerrilla” campaign. Through the investigative and appropriations powers that will come to the new majority beginning in January, Troy says House Republicans will have the capacity to hamper and delay implementation of some aspects of the law while also using the bully pulpit to continue to make the case to Americans why the law is unacceptable.
Owcharenko endorsed that approach. The House majority should use all techniques at its disposal to attack the law, “whether that includes blocking the provisions through defunding….legislative delays and triggers,” resurrecting amendments from the previous battle, challenging HHS Secretary Kathleen Sebelius’s interpretations, or harassment through oversight.
What she recommended against was trying to repair the current law. “You cannot build a consumer-based health care system on a flawed foundation. There’s no reason to negotiate tweaks or fixes when the foundation is unstable.”
Troy cautioned about attempts to repeal only “the most egregious, or most offensive or problematic or controversial” provisions, such as the “burdensome” paperwork requirements the law places on employers. But his warning was strategic, not substantive. “If you get rid of the most egregious, most offensive provisions you may be left with provisions that are not as easily beatable and it would be harder to make the case for repeal in 2012,” he said.
The panel didn’t have any trouble identifying some of those “egregious” provisions: the cuts to the Medicare Advantage; the Independent Payment Advisory Board; comparative effectiveness research; and accountable care organizations, in which, Capretta said, patients could be placed without either their consent or their knowledge. Capretta said that there were opportunities on each of those issues to draw in conservative Democrats, even in the Senate where some, such as Kent Conrad of North Dakota, are facing reelection in 2012 and may well be chastened enough by Tuesday’s results to consider signing onto the Republican cause.
The importance of the states. Although the panel was asked what advice they would give the new Republican majority, several pointed out that many of the important battles will be fought in states, where they hoped that new Republican governors and state legislatures bolstered by large GOP gains will push back against the federal government on health care.
And Badger raised a doomsday – for Democrats – scenario, which is that the Congressional Budget Office vastly underestimated the number of employers who will opt out of providing health insurance, sending untold hundreds of thousands of employees into the federal exchanges. In the words of Capretta, that would create a “gargantuan entitlement explosion,” and — left unsaid — a political catastrophe for the Democrats.
The panelists clearly felt that all of the politics of health reform have now swung toward the Republicans. Even the reportedly popular parts of Obama’s law – for example, the provisions on coverage for pre-existing conditions and extending family insurance to 26-year olds – would not win over voters because of their overall distaste for the law, the panelists indicated. “It’s not an ala carte order where you get to pick a few items off the menu you like and you don’t have to swallow the rest,” said Miller.