View from Washington: Repeal or replace?

Dr. Robert Betz offered some interesting perspective in healthcare legislation in his most recent View from Washington column for JHC:

Many in the health policy community seem to be quietly saying that the Republican led repeal/revision efforts in the House of Representatives are bothersome, but not significant in terms of real changes on the near horizon. Maybe arrogance is not the word, but people down South have a saying that may apply in this case. They describe taking such an attitude as being “10-2.” That being, “they tend-to believe their own bull.” A dangerous disposition regardless of who you might be.

To understand the significance of what the Republicans are about to do, I think you only have to look at when the House voted 253-175 to pass H. Res. 9, which instructs the authorizing committees of House Ways & Means; Judiciary, Education & the Workforce (formerly Education & Labor); and Energy & Commerce, to develop “replacement” legislation for ACA. Fourteen Democrats joined Republicans in voting in favor of this resolution. By a vote of 428-1, the House also approved a Democratic amendment to the resolution directing the Committees to report language permanently fixing the hateful sustainable growth formula used to determine Medicare physician reimbursement rates – commonly referred to as the “doc fix.”

Some say you should not watch sausage or legislation being made. Nevertheless, it is in these authorizing committees where the real revisions to ACA will occur. Some “10-2s” in the policy and media communities seemingly believe that what these committees come up with will only be problematic given the Democrat-led Senate and a Democrat President. I think they are underestimating the Republicans on this. As they say, this is not the Republican leadership’s first rodeo. According to recent polling, the public support for the ACA is soft, and the negatives are still extremely high. Remember that consternation over the ACA was a driving force in the 2010 elections that catapulted the Republicans back into the majority in the House. House Republicans sincerely do have internal issues with Tea Party members, but they will get these handled. More important is if you look at the leadership line-up, these folks are very competent legislators. I think they will take every opportunity – and there will be many this session of Congress – to make significant changes to certain provisions of ACA.

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