America pivoted hard right in Tuesday's midterm elections as angry voters joined the Republican-Tea Party crusade against perceived federal socialism by the Obama administration. Health care reform rivaled unemployment as a hot-button issue with many voters. So how will Republican control of the House affect the fate of the Affordable Care Act, or ACA?
According to a recent article in the New England Journal of Medicine by Brookings Institution economic analyst Henry J. Aaron, Ph.D., health care reform is essentially caught in an abusive relationship between the Party of Yes and the Party of No. Aaron points out that, unlike the legislation that created Social Security, Medicare and Medicaid, not one Republican in Congress voted for the ACA, which leaves little hope for smooth sailing toward full implementation by 2014.
Aaron, who finds much to like about the historic health care reform, says the fatal flaw in the obstructionist viewpoint is that to enact just the insurance-market reforms (no denying or canceling coverage, lifetime benefit caps, etc.) without mandated coverage (everybody in the health insurance pool), as the Republicans have suggested, would not be economically feasible for the insurance industry. Furthermore, mandated coverage without subsidies for those who can't afford health insurance would be grossly unfair.
Republican vows to repeal the ACA will remain toothless taunts, at least through 2013, according to Aaron. That's because both houses of Congress would have to initiate such legislation, unlikely in the face of Democratic control of the Senate -- and even if they did, President Barack Obama's almost-certain veto would require two-thirds majorities of both House and Senate to override.
Of course, should Republicans unseat President Obama in 2012 and wrest control of the Senate, repeal might then become a possibility.
Aaron's deeper concern is that the ACA might suffer the death by a thousand cuts if obstructionists manage to block its funding. He notes that the health care reform contains 64 specific authorizations to spend up to $105.6 billion and 51 general authorizations to spend "such sums as are necessary" over the period between 2010 and 2019.
If obstructionists in either house of Congress hold sway and block funding, the ACA could become what Aaron terms "zombie legislation, a program that lives on but works badly," a true lose-lose-lose scenario for both parties and the nation.
"Such an outcome would trouble ACA opponents: their goal is repeal. It would trouble ACA supporters: they want the law to work. But it should terrify everyone. The strategy of consciously undermining a law that has been enacted by Congress and signed by the president might conceivably be politically fruitful in the short term, but as a style of government it is a recipe for a dysfunctional and failed republic," he writes.
What are your thoughts on the future of health care reform?
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