GOP win means more health­care re­form de­bate

Modern Healthcare - - Contents - NEIL MCLAUGH­LIN Man­ag­ing Edi­tor

When Congress passed health­care re­form leg­is­la­tion ear­lier this year and Pres­i­dent Barack Obama signed it into law, we joked around our news­room that the pack­age amounted to a full em­ploy­ment act for health jour­nal­ists. There were so many pro­vi­sions and ques­tions about im­ple­ment­ing it that we knew it would re­quire weeks and months to sort through it all. Our con­tin­u­ing se­ries “A User’s Guide to Re­form” re­flects that on­go­ing work.

Now, we have an en­tirely new an­gle to cover for per­haps an­other two years: Will the law sur­vive? Last week’s Repub­li­can elec­toral blowout, which shifted con­trol of the House to the GOP and weak­ened Democrats in the Se­nate, raises the specter of re­peal. Repub­li­can law­mak­ers fa­mously op­posed the leg­is­la­tion, and GOP can­di­dates vowed to kill it.

This is not the best news for health­care ex­ec­u­tives. Some didn’t like the leg­is­la­tion be­fore it passed and still don’t to­day, but most have been de­vot­ing time to learn­ing about it and plan­ning for its im­ple­men­ta­tion. The Repub­li­can wins con­jure up the dreaded de­mon of the busi­ness world: un­cer­tainty. What are ex­ec­u­tives sup­posed to do now?

And in­dus­try groups may be feel­ing anx­ious about the pos­si­bil­ity of deals they made dur­ing re­form ne­go­ti­a­tions un­rav­el­ing.

Well, it’s highly un­likely that the re­form act will be re­pealed in to­tal. Democrats still con­trol the Se­nate. And Obama would al­most surely veto any such mea­sure that some­how reached his desk.

Repub­li­cans may try a re­peal, but they are more likely to suc­ceed at cut­ting off fund­ing for im­ple­men­ta­tion of the bill. They are al­most cer­tain to at­tempt amend­ing or re­peal­ing in­di­vid­ual seg­ments of the bill. They likely will take a run at scrap­ping the in­di­vid­ual in­surance man­date, the thread that holds the pack­age to­gether and would fun­nel mil­lions of new cus­tomers to providers and in­sur­ers.

The irony of this sit­u­a­tion, as we have pointed out be­fore, is rich. Repub­li­cans will try to re­peal or evis­cer­ate leg­is­la­tion with GOP roots. The key pro­vi­sions of this bill, such as in­surance ex­changes and even the in­di­vid­ual man­date, were touted by con­ser­va­tive thinkers and politi­cians years ago.

But the de­bate is no longer about pol­icy. Se­nate Repub­li­can leader Mitch McCon­nell of Ken­tucky stated the prime di­rec­tive in an in­ter­view days ahead of the elec­tion. When asked about the top GOP pri­or­ity af­ter the vot­ing, McCon­nell didn’t an­swer with, say, the econ­omy, health­care or de­fense. He said that “the sin­gle most im­por­tant thing we want to achieve is for Pres­i­dent Obama to be a one-term pres­i­dent.”

That is why the re­form de­bate took so long. The ob­jec­tive was to em­bar­rass Obama, not to reach a con­sen­sus. That doesn’t ap­pear to have changed.

More­over, mod­er­ates in both par­ties are an en­dan­gered species. Many mod­er­ate GOP law­mak­ers have been de­feated in pri­maries, and a host of mod­er­ate or con­ser­va­tive Democrats were slaugh­tered last week.

Given the state­ments of po­lit­i­cal lead­ers be­fore and af­ter the elec­tion, the pub­lic and health­care pro­fes­sion­als should not ex­pect any­thing but grid­lock, frus­tra­tion and anx­i­ety for the next two years. It would be nice to have some­thing more pleas­ant for us scribes to write about.

Fi­nally, we note that an­other long­time sub­ject of our cov­er­age—for­mer Columbia/HCA Health­care Corp. chief Rick Scott—won the race for Florida gover­nor. For those of us who have watched Scott over more than 20 years, there is scant ev­i­dence of the sound judg­ment and will­ing­ness to com­pro­mise that are key to good pub­lic gov­er­nance. Per­haps time and the ex­pe­ri­ence of hav­ing to work with leg­is­la­tors and con­stituents will en­lighten Scott. We will keep watch­ing.

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