Thursday, August 26, 2010

The Health Reform Future

The future isn’t what it used to be.


Because of the present political volatility, the future is murky for health reform. It depends on the November 2010 elections. If Democrats hold on, reform may progress along the path President Obama envisions. If Republicans sweep, reform may be delayed, even reversed.

Reform also depends on whether President Obama is re-elected in 2012. And that depends on whether the Republicans by that time have a) a credible messenger; and b) a positive message. It depends on whether the Democratic reform messages play out, a) reform wiil reduce costs and the deficit; b) no one will lose their present health coverage; and c) cuts in Medicare won’t negatively impact seniors.

It depends on whether America’s innovators and entrepreneurs are given enough incentives and room to develop workable alternatives to the present system, which everybody agrees needs reform to slow the pace of growth of health costs.

Finally, it depends on what happens between now and 2014, when the presently planned reforms really kick in. In politics, four years is a lifetime. In the meantime, if Republicans sweep, a big “if”, here is what Republicans may have in mind to delay implementation of the present law, as articulated by Grace Marie Turner, president of the Galen Institute, a market-oriented conservative think tank. (“Putting the Brakes on Obamacare,” August 25, Wall Street Journal).

• Defund it. Choke off funding for implementation of the legislation, starting with parts that are especially egregious such as the "army of new IRS agents" needed to police compliance.

• Dismantle it. Focus committee action and floor votes on its unpopular provisions, such as, all businesses must file 1099 forms with the IRS to report any purchases totaling more than $600 in a year. .The National Federation of Independent Business says this will impact 40 million businesses.

• Delay it. Republicans can also vote to postpone cuts to the popular Medicare Advantage program, postpone mandates requiring that individuals and businesses purchase and provide health insurance, and delay imposition of the $500 billion in taxes required by the law.

• Disapprove regulations. The Congressional Review Act of 1996 (CRA) gives Congress the authority to overturn regulations issued by federal agencies if both houses approve, with a two-thirds majority needed to override a presidential veto. This would be difficult to pull off.

• Direct oversight and investigation. Other aspects of ObamaCare are ripe for public hearings. For example, rules dictating how much insurance companies must spend on direct medical benefits are already hugely controversial—even before they have been issued. Businesses are already aghast about much reform would cost them. Republicans could summon many witnesses to testify about the negative impact of regulatory straightjackets.

These are tricky strategies to carry out. They reinforce the image of Republicans as a party of “No.” What is needed is a positive message of reform that rings true with the American values of freedom, choice, excellence, and individual and financial responsibility.

In light of recent polls, which show a 56/40 voter disapproval of Obama care, Democrats will likely react by softening their reform promises, calling again for a public option, relying on the courts to affirm the constitutionality of the individual mandate, and quietly proceeding with implementation of state insurance reforms and health exchanges.


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