Is Partial Repeal the Right Gamble?

September 9, 2015

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The GOP budget reconciliation bill to repeal Obamacare is back in play – sort of. Republicans appear ready to use reconciliation, which only needs a simple majority vote, to repeal a limited list of Obamacare provisions. However, Morning Consult reports, “the move will be symbolic, since any such legislation heads right to the White House for a veto.”
If true, why are Republicans not sending President Obama a bill to repeal the whole thing, rather than just a few sections of the 2,700-page law?
Might Republicans actually hope he’ll sign it? And if Obama did sign it, would Obamacare ever be repealed?
Consider the biggest winners if the six rumored sections are repealed:
  • Individual mandate (citizens; voters)
  • Employer mandate (all businesses, including tribal)
  • Medical device tax (device manufacturers; insurers)
  • 40% ‘Cadillac Tax’ on high cost plans  (employers; labor unions)
  • Independent Payment Advisory Board (physicians; patients)
  • Expansion of “small group market” definition to companies with up to 100 employees, instead of up to 50 employees as it is today (businesses)
With these repeals in hand, who would fight for a full repeal if a Republican gets elected in 2016? And what highly-visible sections of law could a Republican president use to easily raise the public’s ire?
Despite being 2,700 pages long, much of the public thinks of Obamacare as simply a law about insurance, with mandates, penalties, and a few pluses like being able to get coverage despite being sick. The rest of the Affordable Care Act (ACA) is virtually unknown.
We should not be surprised. A recent analysis of the ACA’s reading level put it at the 13th grade  – harder to understand than an academic paper about chess! (far right line in graph below). Thus, despite former Speaker Nancy Pelosi’s infamous claim, even after the bill’s been passed, people who read it may still not know what’s in it!
If the six sections are repealed, will members of the public raise their voices en masse against the ACA for complex and less tangible sections of the law that are establishing a government-run national socialized health care system?
Will they understand the sophisticated euphemistic ACA terms that put outsiders rather than doctors in charge of medical decisions? For example: ACOs, coordinated care, health homes, team-based care, value-based purchasing, “quality” reporting requirements, bundled payments, lump-sum payments, federal “innovative payment” models and the ACA's readmission penalties?
Will they blame the ACA? I doubt it.
Are the Republicans making a dangerous gamble? If Obama plays to win the endgame (Obamacare Forever), the GOP gamble could go sideways. Congress must keep its eye on 2017. They must make sure they don’t lose the public will for repeal -- and the chance to send a Republican president a one-page bill like H.R. 132 (King) that repeals Obamacare in just six lines of text!
Working for a full repeal of Obamacare,
Twila Brase, RN, PHN
President and Co-founder