Health Care Debate to Intensify, But Big Change is Unlikely


WASHINGTON (December 3, 2010)—Americans should be prepared for two more years of verbal combat over health care reform when the new Congress is seated in January, but wholesale changes to the law are unlikely before the next election, experts say.

Republicans will gain a majority in the House of Representatives when the 112th Congress begins, having gained more than 60 seats, in part by stumping on a platform of repealing the new health care law. But without control of the Senate or the presidency they will most likely be forced to fight by creating bad publicity for the law, experts say, keeping the issue on the national radar screen until a new round of voting, which they hope will get them enough seats to enact substantial change.

But at the moment, "the realistic chances for repeal are about as close to zero as you get in this world," said Henry Aaron, a senior fellow in economics at the Brookings Institution.

"Keeping things aboil until the next election is pretty much in the cards," he said. "There are a lot of folks who want to use every weapon they have to dynamite this thing."

The Patient Protection and Affordable Care Act was signed into law in March and has been a divisive issue in the country ever since, making headlines and spurring votes in the midterm elections last month.

The act was designed to make health care more affordable so that all citizens can be covered, but many of its controversial details, such as mandatory plans by 2014, have drawn battle lines between supporters and opponents.

And although the divide is clear, exactly how a war of publicity will be fought and who will win is still uncertain.

"What (Republicans) can do is they can hold hearings on every bit of bad news (the law) generates for itself," said Michael Cannon, the director of health policy studies at the Cato Institute.

"The Republican House can hold investigations, they can grill them about this law, bring in the victims of this law. There are a lot of things that are unpopular."

By doing this, Cannon said, Republicans create "tough votes or tough vetoes" for the Democrats when and if legislation to change, de-fund, or repeal the law is introduced.

Republicans also hope that more of the public will see for themselves the downfalls of the law as its provisions continue to roll out through 2014.

"The law was designed to front-load the benefits and back-load the costs," said Lisa Wright, a spokeswoman for Rep. Roscoe Bartlett, R-Frederick. "So I would expect the law to become more unpopular going forward."

"Democratic leaders refuse to learn the lesson that they won't be the majority in the 112th Congress because they didn't represent the will of the people when they rammed through the health care law," Bartlett said in a statement.

Andy Harris, the representative-elect in Maryland's 1st Congressional District and soon be the state's only other Republican in Congress, could not be reached for comment. His opponent, freshman Rep. Frank Kratovil, D-Stevensville, voted against the health care reform legislation and touted his independence in his campaign, but was still defeated in November.

Besides repeal, Republicans are considering other legal options. A lawsuit was filed recently by 20 states and the National Federation of Independent Business. Representatives from these states, of which Maryland is not one, are arguing against the constitutionality of the health care reform law. The likelihood of this lawsuit succeeding is still unknown, experts agree.

Trying to withdraw funding from the law is also an option, Wright said.

"The Constitution gives Congress the power of the purse. House members will exercise rigorous oversight and seek to reduce the harm from the law by replacing and improving provisions."

But like repeal, any attempt to deny funds to the Department of Health and Human Services for implementation of the law will be vetoed, Cannon said. But Republicans might attempt this just to build more tension and, in turn, support for repeal, he said.

While Republicans are hoping that with time, Americans will grow more frustrated with the law and its components, what many Democrats are expecting is the opposite—that as the provisions are rolled out, those affected will be pleased with the results and support the law.

"When you go through the bill by what we did, people don't want to repeal it," said Sen. Barbara Mikulski, D-Md., in a written statement. "The two most important things we did were expanding universal access and ending the punitive practices of insurance companies, particularly around pre-existing conditions. When people find that out, they don't want it taken away."

But even Democrats aren't opposed to the idea of tweaking the law.

"There might be some fixes that the president would agree to," said Lawrence Gostin, the faculty director of the O'Neill Institute for National and Global Health Law at Georgetown University.

Mikulski agrees.

"The health care reform bill isn't perfect, but it's a great start," she said. "I would still like to look at how we can reduce the hassle for doctors and how we can bring in more quality standards for better care. But we've seen some great progress already."

Ultimately, all of this fighting might be for naught. There is a chance that the public will tire of the malicious banter and refocus on jobs and the economy in the next election.

"Remember politics has a very short political cycle," Gostin said. "I think this, frankly, is yesterday's news."

Gostin argued that that Republicans have "mistaken the general public sentiment," and that there are specific parts of the law, like the ban on denying coverage for pre-existing conditions, that the public does like. By the time the next election rolls around, he said, there will not be enough political capital to make this an election issue again.

"Holding onto that anger for two more years would be a very hard thing to do."

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