Serious and Not-So-Serious Threats Facing Health Care Reform

The new Republican-controlled House of Representatives may vote this or next week to repeal the federal health care reform bill. The repeal will pass the House. And it will mean absolutely nothing. [Update: House leadership announced on Saturday all floor votes in the House may be delayed one week because of the attack on Congresswoman Gabrielle Giffords, D-Arizona last weekend.]

Not only do the Republicans not have a 60-vote majority to pass a similar repeal through the Senate, a repeal bill would never survive a presidential veto from the man who made health care reform a top agenda of his first two years in office.

While the vote will bring with it an impressive amount of political demagoguery and grandstanding, it will just be the symbolic kick-off to two more tumultuous years for health care reform. As much as many of us were hoping that the battle-weary subject could be put to bed in 2010, this year brings with it a whole new set of challenges.

First, what can House Republicans, united in their opposition to the bill, actually do to alter the implementation of health care reform? After their vote on repeal, which will pass and then languish in the Senate, they will proceed to cull out a number of smaller provisions for repeal, such as the requirement for businesses to file a 1099 tax form for every health care expenditure of $650 and larger, and more controversial ones such as the individual mandate.

The smaller, innocuous issues will likely move through the Senate, while the larger issues will suffer a similar fate of the full-scale repeal vote – a dead end after House passage. They will become fodder, as perhaps intended, for the 2012 elections.

The real tools Republicans have at their disposal are the power of the purse and the power of public exposure. There are no fewer than 30 programs authorized in the health care reform bill that are still awaiting congressionally appropriated funds. I can guarantee that no one is waiting in the Republican House Majority Appropriations Committee office with a checkbook to fund these programs.

The health care bill was written as a comprehensive package, a giant legislative pretzel of commissions, grants, advisory boards, task forces – the list goes on and on. Many of these pieces are interdependent.

A large portion of those 30 or so programs awaiting funding are focused on grants to build up a health care workforce that already is stretched too thin and unable to meet the current demands of the system. Once these programs start to wither from lack of funding, the intention of the whole bill could start to unravel.

I don’t know about you, but I don’t want to be in line at the ER or the doctor’s office the day there are 30 million people added to the insurance rolls. The part of the bill meant to train the health care workers to care for those 30 million new patients never materialized.

The GOP plans to drag an endless stream of administration officials before Congressional oversight hearings to expose deficiencies in the health care bill. This could cause public support for the law to dip below the already anemic rate of 45 percent, where it is currently holding. This lack of support and rising public anger over the bill stoked by House hearings could have serious implications on presidential politics in 2012.

Meanwhile, Republicans trying to undo what they call Obamacare will have to contend with the Congressional Budget Office that estimates repeal of the legislation could increase the federal deficit over the next 10 years by as much as $280 billion. GOP leaders have dismissed CBO's estimate and even wrote their new House rules around this inconvenient budget projection, but that won't automatically make it disappear.

Many states, including fiscally strapped California, are moving ahead full speed with implementation of federal health care reform, which complicate the politics and administrative details of repeal.

And then there is the evidence that some parts of the legislation already in effect, such as provisions extending coverage for young adults through age 26 and addressing pre-existing conditions, are proving very popular with the public. As the administration prepares an aggressive rollout schedule of health care reform implementation and the Republican House plots an attack on all fronts, it’s going to be interesting to have a front row seat to the debate in 2011, because one thing’s for sure; it’s far from over.