WASHINGTON -- If there was one big winner in the budget debates that concluded this week it was not a political party or individual lawmaker, but a singular piece of legislation.
The Affordable Care Act, which took President Barack Obama and Democrats in Congress painstaking months to craft and pass, survived its most threatening legislative test to date. House Republicans, lifted to power in the 2010 elections on a promise to “repeal and replace” the law could do neither. Instead, a series of adjustments were made around the edges, and the debate moved away from the overhaul and on to how to revamp Medicare -- a both more popular and easier-to-defend program.
"Republicans had a choice of issues on which to make a stand and they didn’t chose health care,” said Neera Tanden, Chief Operating Officer at the Center for American Progress, and a member of the president’s team of health care advisers. “It suggests that they are reading the polls which show that the public doesn’t want to revisit the fight, they want to move on and build off of the bill ... The budget battle was as telling for what it didn’t touch as to what it did.”
If the just-completed battle over funding the government did “touch” health care reform it was in the most gentle of ways. Republican lawmakers had initially attached a policy rider to the budget’s continuing resolution that would have restricted funds for the law’s implementation. During negotiations with Democrats, however, they flinched, agreeing to remove the rider in exchange for a simple vote on defunding the ACA. That concession allowed talks to progress. But the end result was predictable: Just like an earlier vote to repeal the heath care law, the vote to defund it failed in the Senate.
Whether the continuing resolution represented the best vehicle for Republicans to gut the law they’ve spent two years demonizing is a subject of honest debate.
Michael Steel, a top spokesman for House Speaker John Boehner, acknowledged that the ACA “largely survived the CR fight,” before adding that “the budget fight is just starting.”
Indeed, the Republican long-term budget document presented by House Budget Committee Chairman Paul Ryan (R-Wisc.) also calls for overhauling the law entirely while making sweeping changes to Medicare and Medicaid.
Democrats, however, were notably chipper when discussing both the events of the past week and the prospects for the president’s signature law.
“It is now up to the courts,” said one high-ranking Democratic Senate aide deeply involved in the CR negotiations. “This was the Gettysburg for them on health care, and they lost.”
A Gettysburg moment would be a cheeky partisan equivalent to the Battle of Waterloo -- the moniker Sen. Jim DeMint (R-S.C.) famously applied to the actual debate over health care reform's passage. But for folks on the Hill, the sense is sincere: defenders of the ACA, one aide put it, "dodged a major bullet."
All of which is not to say that there won't be future moments or legislative vehicles upon which the debate over health care could turn. A vote to raise the debt ceiling is likely to come in May, though there is little talk, at this juncture, about making health care a part of that debate. Ryan’s budget passed the House on Friday. But Senate Majority Leader Harry Reid (D-Nev.) responded with a statement saying the plan "will never pass the Senate."
The funding agreement reached this week runs out by the end of September, requiring another measure to keep operations going. That the GOP could extract concessions in that battle that they couldn’t in the current, favorable, political climate seems unlikely.
The White House is not content, however, to simply let politics run its course. An administration official stressed that the president would make a big push, in the coming months, to implement the provisions of his budget outline that address Medicare directly. This could be done separately or in coordination with the larger budget debates.
But the purpose is the same: to contrast the president’s plan, “which strengthens the [Independent Payment Advisory Board] to help lower Medicare costs,” with the plan endorsed by Republicans, “which keeps the cuts to Medicare [as included in the president’s health care law] in place but gets rid of the subsidies, re-opens the [prescription drug] doughnut hole, and axes small business tax credits,” the official said. “We think we can win that contrast.”
In the meantime, the law will undergo further tinkering. As part of the continuing resolution passed this week, $3 billion in cuts were made from a program that establishes health care co-ops -- an idea championed by Sen. Kent Conrad (D-N.D.) but never loved by the White House. The deal also axed a plan favored by Sen. Ron Wyden (D-Ore.), which was designed to make it easier for employees to scrap their employer-provided insurance in order to buy coverage in public exchanges. Separately, Congress passed a fix to a burdensome tax-filing requirement that no politician seemed to support.
The alterations were political as well as policy-oriented. On Thursday, a new non-governmental group called Know Your Care launched for the purposes of defending the law from attack during the 2012 election cycle and advocating on its behalf through 2014, when implementation begins. Allied groups took their cues as well, arguing that while they were aware the budget fight played out in their favor, it was hardly a time to hail health care reform’s permanence.
“The health care community mostly dodged a bullet on the Affordable Care Act,” said Ethan Rome, executive director of Health Care for America Now. “But this was a skirmish. The real fights come later. They come with the battle over the 2012 budget.”