Obamacare will be on the table in debt talks. Here’s what that might mean.

November 21, 2012

House Speaker John Boehner is turning heads with his new op-ed suggesting that the health-care law must stay "on the table" in deficit reduction talks. 


Washington in one photograph. (Jewel Samad/AFP/Getty Images)

As Kevin Drum has pointed out, this is pretty much the same position that Boehner  has previously staked out. Here's what he wrote today:

The president’s health care law adds a massive, expensive, unworkable government program at a time when our national debt already exceeds the size of our country’s entire economy. We can’t afford it, and we can’t afford to leave it intact. That’s why I’ve been clear that the law has to stay on the table as both parties discuss ways to solve our nation’s massive debt challenge.

 
And here's what he told Diane Sawyer two days after the election:

 

It’s pretty clear that the President was re-elected, Obamacare is the law of the land. I think there are parts of the health care law that are going to be very difficult to implement and very expensive and at a time when we’re trying to find a way to create a path toward a balanced budget, everything has to be on the table. ... There are certainly maybe parts of it that we believe need to be changed — we may do that, no decisions at this point.

The language today was a bit more firm, but the point is similar: The Republican Party supports repealing the health-care law. That's the same position the party has held for over two years, and one that's written into the party platform. Boehner is affirming it, but there's not much he can do about. It's pretty much impossible to imagine House Republicans convincing Obama and Senate Democrats to repeal their signature law, and Boehner basically admits that, suggesting that the Republican strategy now centers around oversight hearings.

That's the story for full repeal. But it's worth remembering that there are a lot of other ways that deficit reduction cuts could reduce spending on Obamacare in a way that would pass muster with Democrats. This could mean cutting back on the health law's Public Health and Prevention Fund, the one that some Republicans have called a "slush fund for jungle gyms." That fund started with $15 billion for the next decade but lost $6.25 billion that went instead to pay for extensions of unemployment benefits.

Congress could continue to tweak the formulas that determine the size of health insurance subsidies. They've done that twice before, reducing spending on this part of the Affordable Care Act so they could continue to keep Medicare doctor payments stable.

Full repeal isn't headed anywhere, but these kind of small tweaks have succeeded before. Similar changes could come up in the next month. While they wouldn't dismantle the law, they could make some minor adjustments that shrink Obamacare's reach. Obamacare is a major source of federal spending at this point. That makes it a likely participant in any discussions of debt and deficit moving forward.

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Ezra Klein · November 21, 2012