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Analysis

Could GOP win truly affect the health-care overhaul?

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The Washington Post takes a look back at some of the more memorable moments from the 2010 campaigns.

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Blake Gopnik at the Corcoran

Day 1
» Chardin

Day 2
» Ter Borch

Day 3
» Gainsborough

Day 4
» Carriere

By Ezra Klein
Washington Post Staff Writer
Monday, November 1, 2010; 12:26 PM

The question is not whether Republicans want to repeal the health-care overhaul. They do.

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"We offer a plan to repeal and replace the government takeover of health care," reads the 2010 Republican Agenda.

The question is whether they'll succeed.

There, the crystal ball gets cloudier. It would be very difficult, if even possible, for them to win a repeal of the Patient Protection and Affordable Care Act. Even in the most optimistic of election scenarios - a world in which Republicans take both the House and the Senate - they almost certainly wouldn't have the votes to overwhelm a Democratic filibuster, much less overturn a presidential veto. The law, most likely, is here to stay.

But that doesn't mean Republicans are powerless. If they control even one chamber of Congress, then they'll have at least partial command over appropriations. And the health-care law needs appropriations. The bill specifically details about 115 of them, some of which are integral to implementation of the legislation. Moreover, Republicans could get even more creative, refusing, for instance, to allow the Department of Health and Human Services to spend staff time setting up the law.

As with full repeal, the GOP would need majorities they don't have to pass any appropriations bills that sabotage the legislation. But unlike with full repeal, where only passing a bill would affect the Affordable Care Act, Republicans can still make their mark by simply refusing to pass any appropriations that would fund the law. And they have more than enough votes to keep any alternatives from passing.

So what happens if Republicans won't pass any appropriations bills that fund the health-care law and President Obama won't sign any appropriations bills that don't? A government shutdown, of course. And there are reasons for both sides to fear that outcome.

Republicans remember Newt Gingrich shutting down the government in 1994 and losing the subsequent public-relations battle. His overreach in that effort broke the GOP's momentum.

Republicans are also aware that though the health-care overhaul is unpopular, its component parts are quite popular. Simply repealing the entire act sounds better than allowing insurers to discriminate against children with preexisting conditions, or bringing back the days of lifetime limits on coverage, or telling insurers they don't have to cover dependents up to age 26. Republicans, in fact, have already struggled with this, implying that repeal would not actually mean the end of the bill's popular provisions - even though they have not settled on a policy that would allow health-care reform to both exist and not exist at the same time.

Democrats, however, know that the health-care overhaul remains unpopular, the economy is grim, and there is no guarantee that Republicans would not fare better this time. There is also the danger of "zombie legislation": a bill that lives on but is strategically undermined so that it appears ineffective, says Henry Aaron, a senior fellow and health care policy analyst at the Brookings Institution.

Politicians of both parties are risk-averse, and the likeliest outcome is that this fight is effectively tabled - particularly if, as predicted, Democrats hold the Senate. Republicans might mount a mostly symbolic vote on repealing the bill, and they could make a show of holding up appropriations in exchange for some smaller compromises on provisions that Democrats won't fight to the death over.

But Republicans are more likely to try to persuade their base to take the longer view and see this battle as one that will really be decided in 2012. Then, they believe, Republicans will have a shot a the White House - anda president whose pen will be on their side.


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