MIAMI -- The debate in the House over whether to repeal health care reform has set up a fairly binary discussion with respect to the law. On one side are Republicans who want it overturned, on the other are Democrats trying to keep the president's signature domestic achievement as is.
In reality, the future of the Affordable Care Act won't lie in either absolute. Rather than disappearing from books entirely, or remaining simply in place, the far more substantive (and enduring) health care reform battle in the next two years will be fought over how and where to amend the legislation.
Already, votes have been taken to revamp the legislation by removing the 1099 mandate, which requires businesses to file an IRS form for any transaction greater than $600. Sens. Scott Brown (R-Mass.) and Ron Wyden (D-Ore.), meanwhile, have introduced an amendment that would allow states to opt-out of the law (provided they meet minimal standards for coverage) more quickly.
Both of these reforms are geared toward mitigating the legislation's reach. And in the future, there seem destined to be major showdowns over funding that could produce similar, scaling-back changes to the law.
But there will also be efforts to build on Obamacare led, primarily, by Democrats disappointed with its earlier reach.
"I do believe it is going to be the impetus for reform," former Democratic National Committee Chair Howard Dean said at a recent Christian Science Monitor breakfast. "I don't believe the health care bill is reform, but I do think it is going to cause reform, because it is causing a significant amount of debate about reform in some really fundamental ways in Massachusetts. Massachusetts is seriously considering getting rid of fee for service medicine. Fee for service medicine is the number one driver of health care cost inflation in this country."
Dean is not, of course, a lawmaker. So his input as to what kind of reforms should be added to the law constitutes little more than a philosophical wish list. (He ultimately predicted that the development of health care exchanges would compel the small business community to "abandon the health care market," a development he called positive). That said, his belief that Obamacare is something to build on -- not the final say -- is shared by others in Congress.
"All of us who supported health care are willing to work with them to improve it," Rep. Peter Welch (D-Vt.) told The Huffington Post. "What Governor Dean describes is the right way to proceed. That may mean modifying some things, scuttling others and adding. It shouldn't be erasing everything we have altogether."
CORRECTION: An earlier version of this article said that Sen. Jeff Merkley had teamed up with Sen. Scott Brown on the state opt-out provision. It is the other Oregon Democrat, Ron Wyden, who is partnering with Brown.