Why Republicans Can’t Repeal Health Care

Defunding isn't a real option, plus their interest group buddies love it

Basking in a post-election glow, Republican leaders are talking about their next fight--repealing health care reform--as if victory is all but certain. Senate Minority Leader Mitch McConnell vowed that his pals in the House must defund the law, while the Senate votes to cancel its "most egregious provisions." John Boehner, the presumptive next House speaker, told reporters that his party must "lay the groundwork before we begin to repeal this monstrosity," MSNBC reports. A campaign-battered Harry Reid admitted he’s "ready for some tweaking" of the law. The GOP is pumped for a health care battle. But many say it’s a battle they won’t be able to win.

• Obama Isn’t Interested in 'Re-litigating' Health Care, Washington Monthly's Steve Benen observes. The president might have said he’s humble in his post-election press conference, but on his signature legislation, he "clearly doesn't seem inclined to budge on this. If Boehner & Co. think Obama will be pushed around on health care, and that with the right leverage, repeal is an option, they're mistaken.” Benen adds that Obama is setting up a narrative: “re-fighting the battles of the past is a mistake.” The message is “all Republicans want to do is fight over things that happened in the past, instead of focusing on the future -- which may come up quite a bit in the coming months. ...  [T]he underlying message to Republicans intending to push for some wholesale overhaul seemed to be pretty straightforward: don't bother."

• Holding Up Confirmations Isn't Enough, Marketplace’s Nancy Marshall Genzer reports. "The Senate is responsible for confirming the heads of new bureaus and offices established by the health care and financial overhauls. Again, Republicans don't control the Senate, but they could hold up those confirmation votes. [Business law professor Jennifer] Taub says that's the reverse of what's needed. Think of the new laws as children.” Taub explains, “The legislation itself, the code, is like the DNA and we need a combination of both nature and nurture for it to thrive."

• Defunding Health Care Isn’t Really an Option, Either, The Wonk Room’s Igor Volsky explains. Boehner and Newt Gingrich have come out in favor of this option, but “that may be easier said than done. As former Senator Tom Daschle explained in a recent interview, ‘a lot of what we did in health care reform has more of an entitlement than a discretionary funding base. So as an entitlement, they would really have to change the law rather than simply not fund in order for it to be effected. The entitlement sections of the legislation are going to be fairly immune from defunding.’ The Congressional Budget Office (CBO) estimates that there is ‘at least $50 billion in specified and estimated authorizations of discretionary spending that might be involved in implementing that legislation’ and presumably that’s the spending Republicans can more easily de-fund."

• And GOP Interest Group Allies Love It, Steve Pizer and Austin Frakt argue at The Incidental Economist. “The Republican base hates health reform because it’s a symbol of Obama. They think it’s a product of the far left, when in fact it’s chock full of Republican  ideas. ... When the new Republican House majority starts legislating on health care, they will be more concerned with what the relevant interest groups want. The insurance industry, hospitals, and drug companies want looser regulation and lower taxes. That is, the big players want what they always want–more control over implementation and establishment of favorable regulations–even if it’s at the expense of a more efficient health system for the rest of us. But they also want the mandate, which can’t work without the subsidies and insurance reforms. The [Affordable Care Act] began as a moderate Republican reform proposal for a reason: with respect to the fundamental structure of the law, the interest group politics work pretty well. We doubt the House leadership will do anything to alienate the insurers, drug companies, or hospitals. Put it this way, if those interest groups didn’t want health reform of the form we got, they would have killed it last winter, if not before. They didn’t. So the mandate and overall structure of the ACA are safe."

• One Small Area of Compromise, The Wonk Room’s Igor Volsky adds, is the law’s 1099 provision.  “Members of both parties have argued that this portion of the law — which was designed to bolster the tax compliance of sole proprietors and pay for coverage expansion — is overly burdensome to small business.” Nancy Pelosi and Obama mentioned the measure as something that needed to be fixed.