If you thought America's health reform debate ended with Vice President Biden's now famous, "This is a big f...ng deal!" comment to the President at the White House signing of the health care reform bill last May, guess again.
The really big deal of health reform in America is just now getting started.
During the past mid-term elections, Republican candidates promised, in no uncertain terms, to repeal and replace The Patient Protection and Affordability Act of 2010, the health care reform law they derisively dubbed "Obamacare." Yet, many Washington insiders feel they are bluffing. In his November 21 "Letter from Washington" in the New York Times, respected Washington journalist Al Hunt, declared that Republican pledges to change the health care law "holds little promise," with "no chance of being achieved."
While I'm in no position to know any more than Al Hunt, or anyone else who dares to predict the future in Washington, my bet is that Republicans could very well radically transform the new law over the next two years as they legislate, investigate, appropriate, litigate and cooperate in the following ways:
Look for a health care repeal to be one of the first bills out of the vote from the House of Representatives, with policy concepts the Republicans could not get included in the President's bill. These include cross state health insurance purchases, small business insurance purchasing pools, support state innovations and capping legal settlements.
Carefully worded legislation that passes in the GOP controlled House could also pass in the Democrat controlled Senate as well. Democrat Senators from red states who watched what happened to moderate colleagues in the last election, might ask Senate Majority Leader Reid (D-NV) for a vote on reforms to the bill. If any changes pass the House and Senate, the President might need to demonstrate he's open to all ideas on health reform and support changes. All of this is a tough path for legislation, but not impossible.
The House of Representatives has appropriation power--they fund or defund legislation. By adding language to their funding bills that forbids spending on the planning councils and agencies created to roll out the new law, they could bring efforts to launch it in 2014 to a grinding halt.
Much of the law was crafted in private meetings, where deals were cut with Democrat Senators, drug companies and the insurance industry. Payment schemes for the new law, which appear to have been cobbled together after the fact, may not work in practice. Simply bringing those discussions to the light of day can create in the mind of the public a whiff of scandal around the law, which could act to undermine its implementation and support.
Fourteen states have GOP inspired lawsuits filed against the law that mandate that everyone be covered. Those suits will probably land in the Supreme Court, where they could find a very sympathetic reception from the Justices. Judging from the current philosophical bent of the Court, a 5 to 4 decision in favor of the states would not be a surprise. There seems to be a real possibility that the Court will declare aspects of the President's health care law illegal.
The GOP runs huge risks of gaining the perception of the "Party of No." It must show it recognizes the problem with health care, has alternatives, and can find common ground with Democrats.
Areas for possible bipartisan agreement in the new law include moving our public health system from a "fee for service" model, which is immune to market forces, to a capitated model (capped fees). This would force competition and innovation. Another area of bipartisan agreement should be investment in IT data driven healthcare initiatives providing better data systems and cheaper technology -- India and Mexico are leapfrogging the US in this arena. Also, there should be bipartisan support for what's called the "leadership pipeline" in health care. The new law offers smart incentives young people who choose health care careers.
What exactly happens to the health care law is anyone's guess, but there's no doubt, that for America, the big deal has just started.
Rich Tafel is President of Public Squared, training nonprofits to engage in public policy. He served as Director of Adolescent Health under Governor William Weld (R-MA). He's also a partner of Corporate Responsibility Partners advising corporations on health and wellness best practices.