The Republican majority has passed a bill out of the House of Representatives to repeal the Patient Protection and Affordable Care Act signed into law last year by President Obama. Though the vote itself is symbolic, the hostility to the law is very real.
Here are the three most important things to understand about the “repeal” effort.
The repeal ain’t gonna happen...yet. The full-scale repeal bill is extraordinarily unlikely even to come up for a vote in the U.S. Senate as Democrats maintain a majority there. However, this may no longer be the case after the elections in 2012. If the Republicans gain a majority in the Senate and win the presidency, all bets are off. The major provisions of the bill aren’t implemented until 2014, so there would still be plenty of time for the Republicans to “repeal and replace” much of federal healthcare reform. Between now and then, they will hold a series of oversight hearings and advance small initiatives designed to defund and otherwise handicap the process of implementing the bill.
Two teams, one endzone. The ironic thing about the “repeal and replace” project is that most of the things that Republicans claim to want to do are already in the law. Healthcare reform is like a football game with two different teams, sets of uniforms, cheerleaders and cheers, but only one endzone. We succeed by providing access to affordable universal coverage, and there aren’t many different plays that will get us there. For example, a key Republican talking point is that the bill didn’t include medical liability reform. This is untrue. The bill does include funding for state-based pilots of different strategies in this area. This is an appropriate response because in all the states that have tried reform in this area, the experiments have either been directly counterproductive or have failed to control costs. The state of California has what most physicians consider the gold standard for medical liability law, and costs have been growing at a faster rate in California than in the rest of the nation. This gets forgotten amidst all the shouting, but there’s a reason we passed the law that we did: it’s a consensus solution that incorporates the best practical ideas from across the political spectrum.
It’s all about the states. Though the vast majority of what is happening in Congress related to healthcare reform between now and the elections of 2012 is going to be political theater, there is real action going on in the state governments. It turns out that far from being a federal government takeover, the law relies on state governments and local delivery systems to put in place the changes that will guarantee access to affordable high-quality healthcare for all. State policymakers are going to be making very important decisions, particularly around the development of the new marketplaces where people will purchase insurance. To the extent that people want to help decide how the bill is implemented, their energies should be focused on state capitals such as Sacramento and on the regulations put in place by the federal government that will structure the actions of the states as well as the incentives of doctors and hospitals in local delivery systems. So this is yet another area in which it necessary to think globally but act locally.
There’s a lot of shouting going on, but you’ve just got to tune it out because there is important work to be done to help ensure a better healthcare system for America.