November 9th, 2012
In the short time that has passed since the election, there have been numerous pronouncements that the struggle over the future of American health care is now more or less settled. And it is certainly true that, over the next four years, full-scale repeal and replacement of the Patient Protection and Affordable Care Act (PPACA) is not in the cards. The president is determined to move ahead with full implementation, of course, and he will not readily sign onto major changes to his signature domestic initiative.
But the 2012 election did not produce a return to 2009. The Democrats do not have supermajority control of the House and Senate, as they did in the 111th Congress when the PPACA was passed. Indeed, in 2013 and 2014, Republicans will have a rather sizeable majority in the House, along with 45 votes in the Senate. In addition, there are now 30 Republican Governors in the states, who will have much to say about health care policy in the coming years, too. So, unlike the birth of the PPACA, its implementation will proceed at a time when Republicans are controlling many levers of power.
Moreover, the president and Congress will be forced by circumstances to address very significant budgetary questions in the coming months and years. In less than two months, the combination of tax and spending policies that constitute the “fiscal cliff” are scheduled to go into effect — against the wishes of leaders in both parties. And early next year, the federal government is again expected to bump up against the statutory limit on federal borrowing. Whether they like it or not, these events will force the president and congressional leaders to engage in a difficult and contentious discussion about how to narrow the massive gap between expected revenues and expected spending commitments in coming years.Read the rest of this entry »