The New Health Dialogue

A Blog from New America's Health Policy Program

HEALTH POLITICS: A Balancing Act

Published:  November 9, 2010
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We all know -- even the Republicans -- that despite sweeping GOP gains, there aren't the votes in the Senate to repeal the health care reform law. Not to mention the fact that President Obama wouldn't accept repeal. But that won't stop Republicans from, as House Republican whip Rep. Eric Cantor (VA) put it, “repealing it piece by piece, blocking funding for its implementation and blocking the issuance of the regulations necessary to implement it.” They vowed to use “every tool” to “achieve full repeal of Obamacare.”

Republicans won't stop health reform dead in its tracks. But a number of experts agree health reform may look different, even a year from now. We tweeted a great Harvard School of Public Health panel on this topic Friday, and we'll recap here. At the bottom of this post, we also have the latest findings from the Kaiser Family Foundation's post-election tracking poll.

Pay close attention to these remarks of Doug Holtz-Eakin, an influential Republican (we aren't sure the Tea Party thinks he is so influential) who directed the Congressional Budget Office and later served as the director of domestic and economic policy for John McCain's presidential campaign.

"We needed health care reform, that was a bipartisan agreement going into the debate, and I think that remains true,” explained Holtz-Eakin. But he added, "what we will see moving forward is that the passage of the law was simply the opening round of the debate over what is the future of the U.S. health care system.”

We can expect that repeal will “pass the House, it’ll die in the Senate and then we’ll get on to the real business,” he continued. He also agreed, broadly, with the wisdom of creating exchanges to sell insurance, although he wanted to make sure states have a lot of leeway.

David Cutler, a Harvard health care economist and former Senior Health Care Advisor to Barack Obama's presidential campaign, is pessimistic about the future of health care reform, and argued that it’s likely we’ll “have an immense stalemate” and “would not be surprised if we shut down the federal government,” a situation that can only be avoided with compromises that he believes are “unlikely.”

One of the greatest points of contention between Republican and Democrats over health care reform is over coverage expansion. Cutler maintains “it’s bad policy to try to save money without covering people,” and that based on that premise alone, “either the Republicans are going to have to make peace” or “there’s just not going to be anything there.”

Robert Blendon, Professor of Health Policy and Political Analysis at Harvard School of Public Health and Executive Director of the Harvard Opinion Research Program, believes the real battles are going to break out around future budgets and that “things that are not currently funded are easier to cut in the future than things that are already paying for people’s jobs … or we can take money out of a bill most people don’t understand.”

Here’s a round-up of our best tweets of the program -- watch the full webcast here.

Live tweeting HSPH's 1:30 program http://bit.ly/a3Gv2C with Douglas Holtz-Eakin, David Cutler and Robert Blendon on the elections & #hcr

Holtz-Eakin: the real contentious issues are in the coverage and budget areas of #hcr

Cutler: It's bad policy to try to save money in health care without covering more people

Blendon: things that are not currently funded are easier to cut in the future then things are already being funded

Cutler: our best guess is that $700B health care dollars are not improving health b/c we haven't figured out how to run the system

#hcr Cutler: health reform took out the micromanaging of Medicare and put it outside of congress, most people agree this is better

Cutler: people know quality isn't where it should be; the point of #hcr was to create a system that day by day will get better

Cutler: Most people would prefer their mothers out of the hospital, instead of inside – care quality needs to be better

Cutler: the bill enables cost savings, it doesn't require it - we'll provide the and put in place the incentives, you figure out how #hcr

Cutler: the reason why estimates only showed $150B in savings from #hcr is bc of the thinking that hospitals will NOT achieve cost-savings

Blendon: Republicans are not going to come to the table looking to deal with the rest of health care system, might do Medicare/Medicaid

Holtz-Eakin: I don’t believe Treasury and HHS can do what #hcr law tells them to do w/ regard to subsidies, can’t calculate for everyone

Holtz-Eakin: active talk right now on setting up exchanges; getting good, solid state-based exchanges where people can shop is a good thing

Blendon: Republican governors will probably wait to see if courts say individual mandate is legal, then come in to start w/ exchanges, etc

Holtz-Eakin: # hcr will experience tremendous oversight from the House, quiet is over, we are about to enter a roar

Blendon: one year from now there will be contentious divisions, this country is moving through very quick political cycles

Holtz-Eakin: discretionary budget process will slow down implementation of #hcr law, it will likely be resolved in 2012 election

Cutler: we will go thru burning bridge in next few months, have or come close to govt shutdown, no clear idea on how to move forward on #hcr

By the way, Kaiser Family Foundation's November tracking poll just came out, and it found that health reform was a factor but not the decisive one in last week's elections. In fact, it came in fourth, but the voters most motivated by health reform tended to vote Republican and strongly oppose the law. And while lots of people want the law changed -- with about equal parts wanting to expand it or strike parts of it -- just 24 percent want complete repeal.

Important provisions remain popular -- even among the pro-repeal crowd. The individual mandate was unpopular -- two thirds wanted that repealed. But even those who back repeal like:

  • tax credits for small businesses offering coverage
  • the prohibition on insurance companies denying coverage based on medical history or health condition
  • the gradual closing of the Medicare prescription drug “doughnut hole”
  • subsidies to help low and moderate income Americans purchase coverage.

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