One Reason Why the GOP Can't Repeal Health Care Reform

GOP House leaders introduced a bill on Thursday to repeal the health care reform law ... the same day the Obama administration announced that it will begin sending seniors the first Medicare "doughnut hole" rebate checks to demonstrate the HCR's benefits to some likely voters.*

Interesting juxtaposition. Stories like this help explain why it's politically implausible to call for health care reform's repeal. The public's opinion of health care reform as a general idea is still mixed. But nothing changes minds like money. Deleting the law means clawing back financial assistance for older Americans with prescription drug bills between $3,000 and $6,000. Seniors are linchpins to midterm success because of their disproportionately high turnout. Republicans know that. Democrats know that. And the administration definitely knows that, which is why it's waging a PR war against Republicans with early rebates checks.

As the health care bill moved through the sausage maker, the benefits moved to the front and the pain moved to the back. In the final reconciliation bill, the subsidies grew more generous, but they're also scheduled to grow more slowly until they eventually fall back to the levels that existed in the House bill, pre-reconciliation. The excise tax on expensive employer insurance plans was delayed until 2018 and hits fewer Americans in the first few years, but it is scheduled to grow faster than in the Senate or House plan. So what we're seeing with the Medicare rebates checks is, for better or worse, something of a microcosm of the bill. Democrats are front-loading the benefits of the plan and leaving the cost-cutting for the second decade.
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*Medicare Part D helps seniors pay for prescription drugs up to a certain level -- about $2,700 -- and above a "catastrophic level" -- about $6,100, but not in between. The health care reform bill gradually fills that gap, which for whatever reason has come to be known as a "doughnut hole."

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Derek Thompson is a senior editor at The Atlantic, where he writes about economics, labor markets, and the entertainment business.

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