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What Does a Republican House Mean for Health Care Reform?

November 4, 2010 at 4:44 PM EST
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Many Republicans campaigned on a platform that included a plan to "repeal and replace" the health reform law. What happens now that they've regained control of the House? Jeffrey Brown gets three views on what's ahead in Washington.
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JEFFREY BROWN: And we turn to health care reform, after Tuesday’s political storm.

U.S. PRESIDENT BARACK OBAMA: We are done.

(CHEERING AND APPLAUSE)

JEFFREY BROWN: It was a heady, even historic moment last March when President Obama signed his landmark health care bill.

PROTESTERS: Kill the bill!

JEFFREY BROWN: But, ever since, and throughout the campaign that just ended, attacks on it continued.

MAN: If we don’t repeal the health care bill, government will grow, debt will explode, choices will become fewer, and your freedoms will be chipped away.

ACTOR: Gramps is sad. Obama cut $455 billion from his Medicare.

JEFFREY BROWN: What now? Yesterday, the presumptive next House speaker, John Boehner, was talking tough.

REP. JOHN BOEHNER (R-OH), House Minority Leader: We have to do everything we can to try to repeal this bill and replace it with common-sense reforms that will bring down the cost of health insurance.

JEFFREY BROWN: Today, though, Senate Minority Leader Mitch McConnell conceded, that will be difficult.

We may not be able to bring about a straight repeal in the next two years, and we may not win every vote against targeted provisions, even though we should have bipartisan support for some of those efforts. But we can compel the administration officials to attempt to defend the — this indefensible health spending bill.

JEFFREY BROWN: For his part, the president said yesterday he would be open to Republican input moving forward.

BARACK OBAMA: If they want to suggest modifications that would deliver faster and more effective reform to a health care system that, you know, has been wildly expensive for too many families and businesses, and certainly for our federal government, I’m happy to consider some of those ideas.

JEFFREY BROWN: And in an interview with ABC News, current House Speaker Nancy Pelosi said that minor changes could be coming.

REP. NANCY PELOSI (D-Calif.), Speaker of the House: I don’t think they’re going to take health care apart. There are certain parts of it that we all may want to review. When we have this debate piece by piece, I think the American people will see how they like pieces of it and how they relate to each other.

JEFFREY BROWN: On Election Day, national exit polling showed public opinion on health care was split — 47 percent said health care reform should either be expanded or kept the way it is, while 48 percent said it should be repealed.

Health care will be part of the agenda when leaders from both parties meet with the president later this month.

And here to assess the state of play: Ron Pollack, executive director of Families USA, a health care consumer advocacy group, James Capretta, a former budget official for health care during the George W. Bush administration. He’s now a fellow at the Ethics and Public Policy Center. And “NewsHour” regular Susan Dentzer, editor in chief for the journal “Health Affairs.”

Welcome to all of you.

Ron Pollack, you were here when that vote passed in March. You supported the health care bill. What message did the voters send on Tuesday?

RON POLLACK, executive director, Families USA: I think the message from voters was essentially jobs and the economy. They’re terribly concerned about the downturn in the economy and their loss of jobs. And I think that was the predominant theme.

Now, with respect to health care, I don’t think health care was a top issue during the campaign. If you take a look at the preelection surveys that were undertaken by Associated Press, the Kaiser Family Foundation, New York Times, they show that most people want health reform to have a chance to work.

Some of them actually want to build on health reform and make it even better and improve it further. I don’t think there is public support for repealing the legislation.

JEFFREY BROWN: You didn’t hear that. James Capretta, what did you hear?

JAMES CAPRETTA, Ethics and Public Policy Center: I heard a strong sentiment for repeal. You know, it was a front-and-center issue. Many, many candidates, both for the House and the Senate, ran explicitly on repeal and replace. And, by and large, they won.

A plurality in the exit polls show that the public would like to see the bill repealed. The number who actually support the bill as passed is less than 47 percent. It’s a fraction of that, maybe half of that. So, there’s a large number of Americans that are very unhappy, both with the process by which it was passed and the substance of what it is.

With respect to the economy, I think what’s clear is, they are very upset that the majority and the president — in the current Congress — passed and were obsessed with passing their version of health care, as opposed to actually addressing the concerns of the economy and jobs.

JEFFREY BROWN: All right, now, Susan, I’m not going to make you resolve this for us, but the analysis continues, right, of what exactly caused particular elections to go one way or the other.

SUSAN DENTZER, editor in chief, “Health Affairs”: Indeed it does, Jeff. I mean, we’re at the point where we stare into the entrails of the goat and try to figure out what the sign is from the heavens about what the voters really believe. I think what is clear is that the rhetoric has shifted a bit already on the Republican side.

From repeal and replace, you now hear Senator McConnell say, in effect, let’s get rid of the worst parts. That’s different from repeal and replace. And, actually, it has invited the administration to come back and say, all right, let’s start to talk about what you view are the worst parts.

Is it the part that would extend the life of the Medicare trust fund by 12 years? Is it the part that would offer coverage for people who are denied it because of preexisting conditions? Is it the part that would repeal the $15 billion Prevention and Public Health Fund, when we know that 40 — going on 80 percent of Americans are likely to be overweight or obese in the next 30 years, and one out of three Americans will develop diabetes?

So, I think we’re going to now start to get to some specifics about what is really meant by what are the worst parts of the law.

JEFFREY BROWN: All right.

SUSAN DENTZER: And then we will see some movement happen.

JEFFREY BROWN: All right, well, that — that puts us forward here as to what might come.

Let me — let me start with you, Ron Pollack, and start on repeal. Let’s stay with repeal for the moment. What — how would it work, and what do you think are the possibilities?

RON POLLACK: Well, repeal is not going to happen.

JEFFREY BROWN: Not going to happen, you don’t think?

RON POLLACK: It’s not going to happen, for a few reasons. Number one, you can’t get repeal through the United States Senate. There are at least 52, probably 53, Democrats in the Senate. They’re not going to vote for repeal. You may need 60 votes in order to pass something that’s so controversial in the Senate. That’s not going to happen.

President Obama still has a veto pen, and he would veto any such legislation. But I think there’s actually something more significant that I think is going to change over time.

And that is that, as more and more people receive the benefits of this legislation, the early provisions, not just the big provisions that get implemented in 2014, things like young adults getting coverage through their parents, children no longer being denied coverage due to preexisting conditions, small businesses receiving subsidies to make coverage affordable, seniors getting money if they’re falling into the doughnut hole, getting tax benefits to help pay for those costs, and, in — in January, they will get a 50 percent discount on prescription drugs.

I think, as more and more of those people receive concrete benefits, they are going to be happy that the legislation passed. Their family will know about it. Their friends will know about it. Their neighbors will know about it. And I think some of the myths that were propagated during the course of the debate will fall by the wayside.

JEFFREY BROWN: All right, now, your turn here, but start with repeal. I mean, do you — they — he’s saying, no way. Do you see any way that that could happen, even with the new political…

JAMES CAPRETTA: Repeal is absolutely a possibility. It’s always been, however, a two-step process.

When they passed this legislation, it was clear there would be two national elections before the main provisions of the bill went into effect in 2014. The voters got to register their views this — just two days ago. They’re going to get another chance in 2012.

I — it’s absolutely certain that the presidential campaign will have health care again as a front-and-center issue. At that point, you will have a possibility for a real debate over what would be the replacement program for what has passed.

JEFFREY BROWN: All right, in the meantime — yes, in the meantime, what — what can opponents do to slow it down or set up roadblocks?

JAMES CAPRETTA: Well, with regard to some of the things that my colleague here has mentioned, the — many of these provisions are very minor in scope in terms of how many people are affected.

By and large, the main effect that’s going to be happening over the next couple of years is large cuts in what’s called Medicare Advantage. Many millions of seniors will get — will see their Medicare Advantage plans actually either close down or lesser benefits than they would have gotten.

Many employers are going to be contemplating large changes in their employer programs because of what’s in the law. They will be communicating a lot to that — their employees. There is going to be instability in the employer market. These provisions will affect many millions of people, many, many more than are covered by these early provisions that have been mentioned.

JEFFREY BROWN: But…

RON POLLACK: You know, we’re talking about instability in the employer market. That’s part of what’s driven the need for health care reform. With each passing year, fewer employers are providing coverage. They’re diminishing what is covered.

JEFFREY BROWN: All right, but let me stop you, because you’re — we’re rearguing the health care bill here. And I’m asking — I’m putting it in the new politics.

I mean, what is — let me go to Susan on this, and then I will come back to you — is that, when you look at the political changes here, are there places where there might be viable places to come together to make some of the changes that we’re talking about here that we heard in the tape?

SUSAN DENTZER: Indeed. I think, as the clip from Speaker Pelosi made clear, there’s agreement across the aisle to get rid of one provision that requires small businesses to report every purchase they make of $600 or more. That wouldn’t take effect until 2012, but it has the small business community up in arms about it, because it would be such a paperwork burden.

There’s pretty clear consensus that will be repealed. It costs about $17 billion to repeal it, so they will have to look around for money to do that. An earlier proposal had been to steal the money out of the Prevention and Public Health Fund, as I mentioned a moment ago. So we will see how that shakes out.

There’s also a proposal afoot to get rid of an independent payment advisory board that would take effect in 2014 that would look to shave money out of Medicare. Now, this is going to produce some real tension within the Republican Party between the deficit hawks in the party and the people who want to buy some support from hospitals or others, particularly in the health care sector, pharmaceutical companies and others, who are fearful of this board.

So, we will have to see how the tensions play out even within the Republican Party on these things.

JEFFREY BROWN: How do you see that playing out? Stay with the political realities here.

JAMES CAPRETTA: Right. Well, I think there are many aspects of the bill that can be addressed, even in the next two years, without full repeal. I think they will pass full repeal in the House, but short of that getting through the Senate and through the president, they can go for a number of things. They can give the states much more authority to be implementer — or to be the drivers of reform, rather than the just implementing what the federal government is telling them to do.

I think they actually could get bipartisan support to actually free up the states, instead of having them really accepting dictates from the federal government. I think there’s an opportunity to stop some of the really bad ideas in the Medicare program. One of our — I have already mentioned cutting Medicare Advantage. That simply puts people back into fee-for-service.

I think you could get bipartisan support around that. I think there are a number of things like that.

JEFFREY BROWN: All right, and a brief last word. I mean, you can maintain what you like about the bill and still have some of these changes?

RON POLLACK: Well, I think there may be some change with respect to malpractice reform. I think there are opportunities for bipartisanship.

But I don’t hear bipartisanship coming from the new leaders. Senator McConnell said his first priority is to defeat President Obama in 2012. That doesn’t sound to me like he’s angling for cooperation.

I think what we are going to see is, I think that Republican leaders are going to try to make sure that the federal government and the states don’t have the resources necessary to implement the legislation, and that may result in a budget impasse.

JEFFREY BROWN: All right. So, this debate clearly continues. Ron Pollack, James Capretta, Susan Dentzer, thanks very much.

JAMES CAPRETTA: Thank you.

RON POLLACK: Glad to be with you.

JAMES CAPRETTA: Thank you.