Repeal ACA, RIP

Someone on twitter (I don’t remember who) last night said RIP ACA repeal, 1/29/14. I agree. That is over.

The release of the Burr, Coburn, Hatch reform plan the day before–that is not a repeal except in the sense of using the word–plus the responses to the SOTU is the elected portion of the Republican party acknowledging that the primary unifying theme of the party for nearly four years (repeal, no clue what after that) is dead. The Burr, Coburn, Hatch plan represents a plausible approach (of course there are many details missing, etc), but, their offer is best understood as an opening bid in a negotiation that will someday ensue. And make no mistake, their offer contains serious policy in the sense that the outrage machine that the Republican party has perfected against the ACA, could be riled by the details necessary to bring about what they propose.

I suspect there are 65-70 votes in the Senate for a plausible reform/modification of the ACA. I am sure I would like some of it and not other parts, but I definitely don’t like the status quo that is an uneven roll out of the ACA in which much of the South is about to be left behind. So, liberals and progressives who deeply care about health policy/reform need a deal that finds the policy that the laggard states will carry out, just as the Republican party needs a deal since they will have great difficulty providing all or most of the votes for any plausible health reform in the near future. As I wrote in 2010, a deal is necessary to do the hardest things, and to the benefit of both sides.

When could it happen? Speaking of fantasies, there seems no way the 65-70 vote Senate block that I think exists could get the House of Representatives to bring such a vote to the floor, unless Speaker Boehner decided that would be his last hurrah. Still, I don’t think it is improbable as was the passage of the ACA in the first place on January 29, 2010. I vividly remember a House staffer telling me in February, 2010 that the only thing they (House Dems) hated more than the Republicans was the entire Senate, and that there was no way the House would pass the Senate bill (but they did, because there was no other choice).

If the Republican Party barely took the Senate in 2014, then the odds of a deal would go up. Post election 2014 is likely the best time for a first deal to occur regardless of Congressional control, so that President Obama himself can provide his approval. Just as there are some who have been reflexively opposed because of him, there are those who support for the same reason and will view any change as a personal insult. It is not. Every health policy person knows there are things that need to be changed and that we will never be done with health reform. For the Republican party, the incentive for a post-2014 election but before 2016 deal are great. If their Presidential primary is driven by a race to the crazy on health reform it will greatly harm their chances in the 2016 general election. And post-tweak, the Dems could run on the mantle of having taken the hard steps, then tweaking the same and preparing to move to the future. May the best man or woman win.

Lots of uncertainty. However, there is one thing of which I am fairly certain. When history views the words spilled against the ACA the past 5 years, there will be a great puzzle when viewed through the lens of what the repeatedly tweak (I hope) health system is likely to look like in 15-20 years.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

3 Responses to Repeal ACA, RIP

  1. Pingback: These two tweets tell you all you need to know about the politics of health reform | The Incidental Economist

  2. Pingback: Read: Austin Frakt on the “the politics of health reform” | The McLean Parlor

  3. Pingback: Patient CARE Act Posts | freeforall

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