False Start

01/20/2011 03:04 pm ET | Updated May 25, 2011
  • Will Marshall President and Founder, Progressive Policy Institute

House Republicans start work today on their first big initiative - repealing President Obama's health care reform. That the new GOP majority has made its top priority a purely symbolic and, let's face it, vengeful act speaks volumes. Don't expect the 112th Congress to be a model of legislative decorum and bipartisan comity.

Sobered like everyone else by the Tucson tragedy, Republicans have promised a "thoughtful" debate. But the sophomoric title of their bill - "Repealing the Job-Killing Health Care Law Act" - gives the game away. Even Speaker John Boehner, supposedly the adult among the new class of conservative enfants terribles, can't refrain from calling the Accountable Care Act "job crushing" and "job destroying" on his website.

In fact, while the new health care law has some flaws, wholesale destruction of jobs is probably not one of them. Although no one can credibly predict the net employment effects of this highly complex reform, it seems likely that adding 30 million new paying customers to health insurance markets would increase demand for medical services.

In any case, House leaders know they can't undo the President's health reform in toto, but nonetheless feel they have to give their militant cadres a chance to get animosity to Obamacare out of their system. Once the House passes the repeal bill, probably tomorrow, it will die in the Democratic Senate. Then Republicans will get down to the more serious business of trying to pick apart the Accountable Care Act piecemeal.

In GOP eyes, the ripest targets include the requirement that everyone buy health insurance, a new long-term care insurance program, and taxes on insurance companies. While few Democrats want to undo the party's historic achievement in finally getting most Americans covered, some will likely join GOP efforts to kill or amend these provisions.

That's especially true of the individual mandate. It is opposed by a majority of voters, and 20 states are challenging its constitutionality in the courts. Yet, as Republicans well know, it's also the linchpin of reform. At the heart of Obamacare is a deal in which insurance companies agree to stop cherry-picking healthy customers and denying affordable coverage to people with "preexisting conditions" in exchange for adding most of the uninsured to their customer base. The deal unravels without the mandate, because then only the sickest people would take advantage of the new law, driving up premiums for everyone. Democrats tempted to oppose the mandate should keep that in mind.

As House Republicans lash the mandate as an infringement on freedom that should stink in the nostrils of all liberty-loving Americans, a little history is in order. One reason we have an individual mandate is that Republicans have opposed alternative ways to extend coverage for all Americans. They successfully blocked President Clinton's employer mandate in 1994. And of course, they vehemently object to a national health care system that insures everyone (and taxes them to pay for it) whether they want it or not.

In reality, no truly voluntary health scheme can get around the adverse selection problem. The individual mandate is an imperfect solution, but the right question is, compared to what? The "alternatives" advanced by the GOP last during the great debate over Obamacare did not even pretend to cover most of the uninsured.

As Jill Lawrence reports in Politics Daily, health policy analysts are thinking creatively about different ways to induce people to seek health insurance. But the last thing House Republicans want to do is to improve Obamacare. Their goal is evisceration.

That's too bad, because the nation could use a serious debate about refinements in the $1 trillion Accountable Care Act. The new long-term health care benefit incorporated in the bill (the Class Act) does need a second look from budget-conscious lawmakers. It's especially important that the Act's rather weak cost containment provisions be strengthened. And there will be plenty of adjustments to be made as this enormous bill is implemented between now and 2014, when its main provisions fully kick in.

In short, a party serious about governing would seize the opportunity to make fundamental improvements in the 2010 health reform law. In embracing a rollback strategy instead, House Republicans have gotten off on the wrong foot.

This item is cross-posted at Progressive Fix.