When Congress passed healthcare reform legislation earlier this year and President Barack Obama signed it into law, we joked around our newsroom that the package amounted to a full employment act for health journalists. There were so many provisions and questions about implementing it that we knew it would require weeks and months to sort through it all. Our continuing series “A User's Guide to Reform” reflects that ongoing work.
A wrench in the works
GOP victory promises to tangle up implementation of reform
Now, we have an entirely new angle to cover for perhaps another two years: Will the law survive? Last week's Republican electoral blowout, which shifted control of the House to the GOP and weakened Democrats in the Senate, raises the specter of repeal. Republican lawmakers famously opposed the legislation, and GOP candidates vowed to kill it.
This is not the best news for healthcare executives. Some didn't like the legislation before it passed and still don't today, but most have been devoting time to learning about it and planning for its implementation. The Republican wins conjure up the dreaded demon of the business world: uncertainty. What are executives supposed to do now?
And industry groups may be feeling anxious about the possibility of deals they made during reform negotiations unraveling.
Well, it's highly unlikely that the reform act will be repealed in total. Democrats still control the Senate. And Obama would almost surely veto any such measure that somehow reached his desk.
Republicans may try a repeal, but they are more likely to succeed at cutting off funding for implementation of the bill. They are almost certain to attempt amending or repealing individual segments of the bill. They likely will take a run at scrapping the individual insurance mandate, the thread that holds the package together and would funnel millions of new customers to providers and insurers.
The irony of this situation, as we have pointed out before, is rich. Republicans will try to repeal or eviscerate legislation with GOP roots. The key provisions of this bill, such as insurance exchanges and even the individual mandate, were touted by conservative thinkers and politicians years ago.
But the debate is no longer about policy. Senate Republican leader Mitch McConnell of Kentucky stated the prime directive in an interview days ahead of the election. When asked about the top GOP priority after the voting, McConnell didn't answer with, say, the economy, healthcare or defense. He said that “the single most important thing we want to achieve is for President Obama to be a one-term president.”
That is why the reform debate took so long. The objective was to embarrass Obama, not to reach a consensus. That doesn't appear to have changed.
Moreover, moderates in both parties are an endangered species. Many moderate GOP lawmakers have been defeated in primaries, and a host of moderate or conservative Democrats were slaughtered last week.
Given the statements of political leaders before and after the election, the public and healthcare professionals should not expect anything but gridlock, frustration and anxiety for the next two years. It would be nice to have something more pleasant for us scribes to write about.
- Finally, we note that another longtime subject of our coverage—former Columbia/HCA Healthcare Corp. chief Rick Scott—won the race for Florida governor. For those of us who have watched Scott over more than 20 years, there is scant evidence of the sound judgment and willingness to compromise that are key to good public governance. Perhaps time and the experience of having to work with legislators and constituents will enlighten Scott. We will keep watching.
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