House Votes to Repeal Healthcare Reform Legislation—What Next?

Crystal Kuntz, MPA

February 2011, Vol 2, No 1 - Health Policy

On January 19, 2011, House Republicans voted 245-189 to pass a bill that would overturn the comprehensive healthcare reform legislation. The vote was seen by many as sym bolic, as Republicans face significant roadblocks in their effort to fully repeal last year’s healthcare overhaul. Democrats in the Senate have said they will not allow a similar bill to move forward in the upper chamber. And, even if such a bill were able to get through the more closely divided Senate, Presi dent Obama would certainly veto it.

The Republican vote, however, does mark the beginning of a lengthy debate on healthcare that will likely continue between Republicans and Democrats throughout 2011.

The next salvo in that debate was fired on January 31, 2011, when US District Judge Roger Vinson of Florida ruled that the healthcare reform law was unconstitutional because of its mandate that Americans have health insurance beginning in 2014.

However, the ruling has no immediate effect pending resolution on appeal and likely will have to be decided by the Supreme Court—a process that will take at least a year or more.

Absent the ability to fully repeal the legislation, Republicans will start focusing on strategies aimed at dismantling the legislation “piece by piece.” One tactic would be to try to “defund” specific provisions in the healthcare legislation. However, such a strategy is not assured of success. Spending for healthcare reform is intricately linked to spending for hundreds of other programs that are contained within the large appropriations bills Congress must pass each year to fund the government, making potential cuts even more controversial.

Republicans will aim to hold numerous congressional hearings on the Democrats’ healthcare legislation, with the goal of demonstrating that the Democrats’ approach is too costly and ineffective.

Republicans will also push “smaller” government solutions to address the problems of the uninsured. For example, Republicans would like to bring down costs by allowing families and businesses to buy health insurance across state lines or by giving individuals, small businesses, and associations the ability to form insurance pools. Another Republican priority is legislation aimed at addressing the costs of malpractice insurance and what they believe are frivolous lawsuits.

In his State of the Union address on January 25, the president signaled his willingness to work with Republicans on certain improvements to the comprehensive legislation. Somewhat of a surprise was the president’s interest in medical malpractice reform, an issue traditionally advanced by Republicans but almost universally opposed by Democrats. He also expressed support for a less controversial fix to a provision in the law that imposed a tax paperwork burden on businesses.

At the same time, the president set forth a strong defense of his health overhaul and stated that efforts should focus on improving—not dismantling— the legislation from 2010. He cited examples of how the insurance market reforms are already benefiting individuals, such as requirements that prevent denials of coverage based on preexisting conditions and require coverage of children and young adults under the age of 26 as well as a new program to provide cost-sharing assistance to enrollees in Medicare Part D.

It is too early to tell whether Republicans or Democrats will be more successful in making their case to the American public on healthcare reform and potential next steps.

Further complicating the matter is the sharp division between the American public on the issue. A recent survey from the Kaiser Family Foundation found that 26% of the public favored full repeal, 25% favored repealing some parts of the law and keeping other parts, 21% favored keeping the law as it is, and 20% favored expanding the law ( pullingittogether/repeal.cfm). It is also unclear how much of an appetite the American public will continue to have for healthcare issues as the economy continues to struggle.