the cost of repealing health reform


“Medicine may be hard, but health insurance is simple… The subject’s famed complexity is a function of the forces protecting the status quo, not the issue itself.”

-Ezra Klein

When first brainstorming ideas for this blog, it seemed inevitable that the subject of health care in the United States would eventually come up.  What I did not expect was to spend the first substantive post discussing the Patient Protection and Affordable Care Act, the health care reform bill passed under Obama last year.  The legislation has passed, provisions are already being implemented, and the majority of Americans with opinions on the matter want it to remain in place [1].  It might seem odd, then, that following a resounding electoral victory in November, House Republicans have dedicated their first major legislative agenda to repealing this legislation.  While both sides of the isle recognize the slim likelihood of the effort coming to fruition, the fervor with which Republicans have attacked these reforms provides us with another opportunity to consider the merits of the legislation and the motivations behind Repulicans’ ardent opposition.

Before we discuss the case against this legislation, it is perhaps helpful to review what the reforms do and, consequently, what their repeal would mean.  This bill…

  • Extends health insurance to roughly 32 million currently uninsured
  • Lowers the cost of prescription drugs for seniors on Medicare
  • Prevents insurance companies from denying children or adults care based on pre-existing conditions
  • Prevents insurance companies from dropping individuals’ coverage when they get sick
  • Prevents insurance companies from imposing annual or lifetime caps on the amount of medical care a person may receive

…as well as dozens of other provisions detailing exchanges where individuals may shop for insurance, a framework for states to sell policies across state lines, tax credits for small employers, and much more [2][3].  These reforms would of course disappear if the PPACA were to be repealed.

The Case Against Health Reform

Polling has shown that the vast majority of the individual provisions enjoy public support [4], so why have conservatives waged such a tireless campaign against it?  The reasons have evolved over the course of the debate, but the primary arguments have been threefold: (1) the legislation is too costly, (2) the individual mandate overreaches the role of government, and (3) the legislation will cost America jobs.  Let’s examine these one at a time and try to gain some insight into the arguments being presented.

John Boehner

Speaker of the House John Boehner (R-OH)

The charge that the legislative package is too costly was one of the first to be leveled, and it has persisted now for more than a year.  Of the three objections presented, however, this one appears least credible.  Due to a combination of cost-cutting measures and new taxes and fees, the legislative package is entirely paid for.  The nonpartisan Congressional Budget Office estimates that the legislation will reduce the federal deficit by around $140 billion dollars over the first 10 years, and its latest report pegs the cost of a repeal at $230 billion dollars over the next decade [5].  Budget analysis aside, it would appear that the Republicans themselves have stopped believing their own argument.  When passing the rules for the new House, Republicans implemented a policy they termed “cut-go,” the essence of which is that any new legislation passed that would increase the deficit must be offset by cuts made elsewhere.  When penning the new guidelines, however, Republicans added an explicit exception for the health care law, tacitly acknowledging that its repeal would substantially increase the deficit and thus must be excepted from the new ground rules [6].

The second objection made to the new legislation is that the individual mandate, the portion of the law requiring that all individuals carry health insurance, is an inappropriate overreach of government’s authority.  Variations on this have ranged from ideological disagreements over the role of government to legal claims that the new law is unconstitutional, with multiple states having filed suit to that effect.  This last matter will inevitably be decided in the courts, but neither side is banking on the law being overturned.  While there are no doubt a great many individuals who truly see this as a conflict, the objection rings hollow coming from the Republican establishment laying the charge.  If the debate over an individual mandate sounds familiar, that’s because it was discussed 15 years ago… when Republicans first proposed it [7].  In fact, several of the Senators who sponsored the original bill are not only still holding office but are spearheading the outrage against it.  What’s more, the current front-runner for the 2012 Republican Presidential nomination, Mitt Romney, oversaw the implementation of a very similar model in his home state of Massachusetts [8].  After such longstanding support from Republican leadership, it’s difficult to view the current outrage as a true moral objection rather than a tool being wielded for political ends.

The final objection, the negative effects of the legislation on the job market, is a rather recent one, only coming to the forefront after Republicans campaigned on a platform of job growth.  To tie job creation and health reform repeal together into one political package would prove quite the messaging victory, but here, too, the claims made fall short of the data.  Republicans argue that the health care legislation will destroy jobs in some areas, going so far as to name their legislation the “Repealing the Job-Killing Health Care Law Act”, while Democrats argue that it will create jobs in other areas.  Most independent analyses have projected only a small negative impact on job numbers, primarily amongst minimum wage employees, offset by gains in jobs within the health care industry [9].  The CBO predicts a decrease of roughly one-half of one percent of the labor force but notes that this decrease will be almost entirely due to workers being able to work less or retire early because of the law, hardly a negative in most peoples’ minds [9].  Still, these numbers have not staved off a relentless campaign of bad data from House Republicans, from gross misrepresentations of the above CBO report to repeated citations of a study examining an earlier (and no longer applicable) version of the health care law by both Speaker Boehner and Majority Leader Eric Cantor [9][10].  This objection, more than any other, is thick with what appears to be willful intellectual dishonesty.

Incentivizing the Status Quo

If the fervent opposition to the current health care reform law stemmed from simple disagreement over the merits of policy, that would be one thing.  Individuals from either end of the political spectrum could present different items for consideration, and we could then do our best to ascertain how these would impact the people of this nation.  What we have seen from Republicans so far, however, has been opposition to health reform for health reform’s sake.  Objection after objection has been brought forward not out of some deeply held moral conviction but as tools to be wielded to a political end.  The continued dissonance between reality and rhetoric suggests that the issue at heart here is not the merits of the legislation at hand.

Franklin Delano Roosevelt

FDR first called for a national health program in 1939

To what end, then, is the unending campaign against this policy?  We could certainly speculate and draw reasonable conclusions from the information available, but Republican leadership has already publicly stated what their aim is.  When addressing the Heritage Foundation, a prominent right-wing think tank, Senate Minority Leader Mitch McConnell frankly noted, “our top political priority over the next two years should be to deny President Obama a second term.”  Since Franklin Delano Roosevelt’s first effort in 1939, a system of national healthcare has been a major goal of American progressives for nearly a century.  In passing even the small reforms that he has, President Obama has established a legacy that will likely far outlast any other acts of his presidency.  To enact substantive health reform in this country is a major victory for the liberal agenda, and the Republican establishment knows it.  What’s more, they realize all too well that the problem with sweeping social programs is that, once established, they tend to be extraordinarily popular.  Conservatives fought tooth and nail against Social Security and Medicare, and now those programs are sacrosanct amongst American politics.  They know they must fight this law now and by any means necessary, regardless of its actual merit, lest liberal ideology gain another small foothold in the American psyche.

The truly unfortunate consequence of this ideological backlash, then, is that the welfare of the American people is taking a back seat to a partisan agenda.  The state of health care in this country is not simply a matter of academic debate.  A recent study by Harvard Medical School estimated that nearly 45,000 Americans die every year from lack of health coverage [11], nearly eight times as many as have died in the entire Iraq and Afghanistan wars combined.  In what is the wealthiest nation that has ever existed, it is morally repugnant that we feel so little impetus to meet such a basic need of our fellow citizens.  Such a systemic problem should at minimum warrant a good faith effort by all those involved; failure to do so reflects poorly on the character of our nation and does a grave disservice to the millions of men and women who want nothing more than to see a doctor.


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