The House of Representatives voted to repeal the Affordable
Care Act for the 40th time last week. It did this before balancing the budget,
passing a jobs bill, reforming election laws, or anything else that might
actually improve its
standing in the eyes of the general public.
So what began for some members of Congress as principled opposition
to federal “overreach” has turned into a political punch line:
“How many more votes will it take for the House of Representatives to repeal Obamacare? It doesn’t matter, because the House doesn’t
count anyway.”
The very first column I wrote after the mid-term election in
2010 was entitled “Six
Reasons Why Health Reform Won’t be Repealed.” In it, I argued that there were at least five
substantive reasons why the Affordable Care Act would not be repealed in spite
of the Republican House takeover. These
included the popularity of the expanded Medicare benefits, the benefits to early
retirees, the benefits to adult children, and the benefits to those with
chronic conditions.
I concluded with a political reason. People who were already upset at the high
cost of health insurance would never vote for someone who would vote
consciously to make that cost even higher.
That is as true today as it was then.
So, almost three
years later, here are six more reasons why Obamacare will remain the law of the
land even after 2016, no matter how many more meaningless repeal votes the
House takes between now and then, or how many Senators suggest shutting down
the government to prevent its implementation.
First, states with expanded Medicaid programs will never
support the repeal of that provision of Obamacare.
That means that neither will most of their members of
Congress, no matter how they vote for show.
At present, those states have 205 representatives in the House. By the end of the year, that number should be
closer to 238. In other words, by next
year, states with expanded Medicaid programs will have a majority in the House
of Representatives.
Second, the infrastructures to implement Obamacare in all
fifty states are now being established – and one of these is an advocacy
infrastructure. Ironically, the advocacy
infrastructures may become even more potent in states that have opposed
Obamacare. Because those state
governments are giving them no help, they can marshal anti-government on behalf
of Obamacare. For example, the
enrollment efforts of Florida CHAIN and
its allies already show an impressive level of planning and sophistication. And they will only get better in the days to
come.
It is difficult to
repeal any governmental program. It is
even more difficult when there is an organized effort to protect it.
Third, the existing Medicare program for current and
newly-enrolling Medicare beneficiaries is still untouchable for politicians.
That includes the Obamacare changes that are now an integral
part of Medicare – better prescription drug coverage and better wellness
benefits. Imagine being the politician who
wants to take away those!
Fourth, unless and until the Congressional Budget Office
changes the way it projects budget impacts, you can’t repeal Obamacare without
adding to the deficit. And, for the
record, no one in office or running for office favors adding to the deficit.
Fifth, too many people – as many as 25-30 million, by most
estimates – are going to benefit directly from the tax credits beginning next
year. If you repeal Obamacare and raise
the annual cost of their health insurance by thousands of dollars, they will
notice. Suggesting that they can just
become uninsured probably won’t cut it. And
they will probably vote against you in the next election.
And finally, the
House lost the issue’s long-run political debate right after the 2012 election,
when it replaced “repeal and replace” with simply “repeal.”
“Repeal” may be easier to argue in the short-term, but
opponents have to have a plausible alternative to Obamacare to build their
constituency. And they don’t have one.
So whether or not Obamacare becomes more popular in the days
to come, to most people it will be much better than nothing.
Even if the House casts forty more votes to repeal it, and
even if more senators join the tin-eared chorus threatening to shut down the government
over its implementation, Obamacare is here to stay.
And all the members of Congress already know this.
Paul Gionfriddo via email: gionfriddopaul@gmail.com. Twitter: @pgionfriddo. Facebook: www.facebook.com/paul.gionfriddo. LinkedIn: www.linkedin.com/in/paulgionfriddo/
Gorgeous!
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