The New Health Dialogue

The Alliance for Health Reform held a session on the political future of the Affordable Care Act today, and here are some highlights (slightly delayed after my netbook went into a deep dark and mysterious hibernation from which it just awoke). All three speakers predicted a three-pronged attack by House Republicans.

Legislative (repeal or repeal and replace or some variant). Appropriations to try to "defund" reform. Neither are likely to succeed. And, third, oversight hearings, repeatedly grilling top Obama administration health officials, which is also a way of fighting what one of the speakers reminded us was the real battle to preserve the benefits of health care -- the battle for the hearts and minds before the next election.

Norm Ornstein of the American Enterprise Institute said the 2010 Congressional election was the third consecutive "wave" election and it reflected a lot of dissatisfaction with the status quo. He predicted 2012 would be a fourth wave -- but said nobody can yet know which side in a divided government will be caught in the undercurrent. He also noted that if President Obama tacks center, he'll get grief from the base (much of which already thought health reform fell short) and possibly open himself to a challenge from the left. Ornstein predicted that the "repeal" promise would create problems for the Republicans because "when you start to parse out the individual provisions (of the Affordable Care Act) most are pretty popular," except the individual mandate. And if you try to strike the individual mandate while leaving the ban on excluding people with pre-existing conditions "it's an impossible situation."

Shutting down the government over funding health care is politically risky -- although he thought there is some possibility there would be targeted shutdowns over, say the appropriations bill that funds labor and health. But if you shut down HHS, you don't just shut down a health reform office -- you shut down ALL of HHS. And HHS includes Medicare, Medicaid, the NIH, the CDC, the FDA. "A lot of things that people may not find very comforting [to have shut down]."

Dean Rosen, a health attorney who has worked for top Republicans in Congress and the insurance industry, said the main message from voters was jobs and the economy -- but it was also a big loud concern "about government overreach" and the deficit -- opposition to health reform plays into that. Many voters, he said, believe that health reform is the embodiment of a government that has grown too fast, and is spending too much. And they either don't know or don't particularly care that the costs of health coverage expansion are offset. He expects House Republicans to vote to repeal the law, because so many of them campaigned on it.

In addition to the 60-odd House seats the Republicans picked up, another 20 or so House Republicans will be freshman, replacing people who retired or went on to other offices. So one third of the House will be new, and about a third of the new Republicans are new to public office altogether, determined to come here and bring about change. But at the end of the day, the Senate and the White House do remain in Democratic hands.

The AARP's John Rother struck a slightly different tone. "I do think it's easy to over-interpret the election results... and over-dramatize the impact on health reform," he said. Midterm voters aren't the same as the voters that turn out in a presidential election year. "The election that matters for health reform is not the one we just had but the one we will have," he said. He pointed out that many industries remain supportive of the health reform law, understanding that the status quo is not sustainable. The real battle, he said, isn't about what oversight hearing or held or what House votes pass. It's about rolling out the reforms, having people understand what they gain from health care reform. It's about the "hearts and minds of the American public."