Friday, January 7, 2011

Can the GOP repeal the Affordable Care Act?

The 112th House of Representatives has scheduled a vote to fully repeal health reform on January 12th. Could this actually happen?

Short answer: No.

Long answer: As many of the new members ran on the ‘Repeal ObamaCare’ mantra, the vote is little more than a political stunt to appease the base and reiterate the fact that Republicans did indeed gain the House majority in the 2010 midterm elections; the vote to repeal will pass the House and be killed in the Senate, where Dems still enjoy the majority.

The symbolic vote is only the start of the attacks on the new law, though. Over the following months, there will be numerous attempts to defund certain provisions in the law that are required to first be appropriated by Congress in the annual budget. Every year, Congress must approve the federal spending package, and numerous pieces of health reform face this second hurdle. Provisions that could be threatened include the new long-term care insurance program (CLASS Act), the new Public Health and Prevention Fund, and some of the funds needed for expanded federal regulatory personnel to implement the law.

That being said, the central pillars of the ACA are more or less protected from Congressional action and enjoy permanent funding authority. These include all the funds related to insurance expansion like the insurance exchange subsidies and Medicaid expansion, investments in primary care and community clinics and payment/delivery reform pilot programs (Pay for Performance, reducing hospital readmissions, etc). Interestingly, the law provides expanded authority to the Department of Health and Human Services (HHS) allowing for the Department’s independent funding of ‘related provisions’ without seeking appropriations through Congress, essentially creating a backdoor to funding streams that may not survive the appropriation process. And of course, the individual mandate is facing it's own battle in the courts

Curious as to what the effects of repeal would be? Here are just a few of the more immediate effects:

-Allows insurance companies to drop children under 26 from their parents’ plan
-Adds $230 Billion to the federal deficit
-Increases drug prices for seniors, and removes their ability to receive free preventive screenings
-Allows insurance companies to deny coverage to individuals with pre-existing conditions

To be clear, there are a number of things that do need to be tweaked in the law. Until the politically-driven nowhere-votes cease, though, these adult legitimate conversations can never happen.

No comments:

Post a Comment