The House of Representatives began debate today on its bill to repeal the Affordable Care Act. The GOP has the votes it needs to get it passed, but it will go nowhere in the Senate.
But the vote is more than symbolic, as some press reports have labeled it. There is more than symbolism at work when the House of Representatives decides, as its first order of business, to vote to dismantle the work of its immediate predecessor. Rather, it signals that the Republican-controlled House is serious about mounting a sustained effort to use every tool at its disposal to repeal, halt and defund the law, in pieces if not all at once. Interestingly, the House is taking on this fight at time when the level of strong opposition to the ACA is near an all-time low according to a new AP poll.
Instead of a fight that will be won or lost on a single battlefield, think of it as series of guerilla actions by the GOP to weaken the law, in the hopes of ultimately bringing it down.
Readers of this blog know where I stand on repeal: the Affordable Care Act isn’t perfect and can and should be improved, but turning away from its promise of (near) universal health insurance coverage would be a terrible mistake. Repeal would result in at least 32 million more Americans going without health insurance, the continued erosion of private employer-based health insurance coverage, more people ending up in under-funded safety net programs, and elimination of some of the most promising initiatives to begin to bend the cost curve.
Coincidental to tomorrow’s vote (since the publication schedule was set months ago), health reform is a major focus of today’s edition of the Annals of Internal Medicine. It includes my article (originally published in December as an early web release) on the consequences if the United States allows universal coverage to slip away, and several letters to the editor taking issue with the August 23 article by White House staffers Zeke Emanuel, Bob Kocher, and Nancy-Ann Deparle. The letters, and the authors’ response, makes for interesting reading.
Also today, ACP released a statement to urge Congress to "preserve and – as necessary – improve on [the] important reforms created by the Affordable Care Act, not repeal them.” The statement lists “essential” policies that need to be preserved, including provisions to provide coverage to nearly all Americans.
But ACP also advocates that “Congress and the White House . . . work together to find effective ways to restrain cost growth and ensure effective implementation of the law [including] . . . enacting more effective medical liability reforms, ensuring that states are granted the flexibility and resources they need to effectively expand coverage, giving Congress more decision-making authority over recommendations from an independent payment advisory board, and replacing the cycle of Medicare physician payment cuts caused by the Sustainable Growth Rate (SGR) with a permanent solution. Other improvements should include removing or modifying the burdensome 1099 reporting requirement for small businesses and the requirement that physicians provide written authorization for over-the-counter medications reimbursed by a flexible spending account. Such improvements, though, should not compromise necessary funding for other essential policies in the ACA.”
My fervent hope is that Congress will move away from framing the issue as being a yes or no choice between repeal or keeping the law unchanged. The GOP might listen to the sage advice of one of its own, former Senate majority leader Dr. Bill Frist, a heat surgeon from Tennessee:
“The reality is that the law will remain largely intact. . . That being the case, is it is important that it be made to work as effectively as possible . . . there are lots of things that can be fixed or modified by working together.”
This would be good advice as well for President Obama and the Democrats. Wouldn’t making the law “work as effectively as possible” by “working together” to fix or modify it be much more constructive, and unifying for the country, than a no-win fight over repeal and replace?
Today’s question: What is your reaction: after tomorrow’s “symbolic” vote on repeal, should the 112th Congress heed Dr. Frist’s advice to take the next two years to work as effectively as possible, or continue to fight to repeal or weaken it?