Politics & Policy

Obamacare: The Next Battles

From the May 3, 2010, issue of NR.

The first steps toward the repeal of Obamacare have already occurred. First, the legislation passed without leading to a lasting improvement in the president’s or the Democrats’ approval ratings. Second, in part as a result, it has quickly become Republican-party orthodoxy that the new health-care legislation needs to be repealed and replaced with conservative reforms. Two Republican senators who seemed to throw cold water on repeal, John Cornyn of Texas and Bob Corker of Tennessee, promptly clarified that they support the goal.

Many important questions about how to repeal Obamacare, and exactly what reforms to replace it with, remain unresolved. But that’s fine. Those questions do not have to be resolved right now, when conservatives and Republicans have no power to set the agenda in Washington, D.C. For eventual repeal to be possible, what needed to happen soon after Obamacare’s enactment was for Republicans to commit themselves to the goal. To a large extent, that has happened. Republicans who are running for office this year, in particular, are advertising their desire for repeal.

The fledgling campaign for repeal is drawing a lot of scoffs. Repeal is said to be a pie-in-the-sky aspiration. No doubt some of the Republicans who say they favor it also privately regard it as impossible to attain and unreasonable to seek. A lively debate has broken out on the feasibility of repeal, with skeptics — including both jubilant liberals and despairing conservatives — tending to rely on generalizations about the difficulty of undoing entitlements and conservative optimists finding vulnerabilities in specific features of Obamacare.

Full repeal won’t be possible until 2013 at the earliest. But events during the rest of 2010 will exert a powerful influence on whether Obamacare is eventually repealed. For repeal to be plausible, several things have to happen.

Republicans have to stop being scared of Obamacare’s “popular features.” A common theory on the left is that Obamacare’s individual elements are popular even if the whole package isn’t. It follows that Obamacare will become more popular as these components go into effect and that Republicans will oppose them at their peril. Some Republicans have come to accept these assertions, which accounts for their lingering doubts about repeal.

Here is what can be said with confidence about the polling. First, most people do not have strong views about the details of health-care policy. The results of polling on such issues as the public option and the employer mandate have been highly dependent on the wording of the questions. Second, some elements of the plan poll well in general but others do not. The public does not, for example, seem to be fond either of the cuts to Medicare or the requirement that everyone buy insurance on pain of fine. Third, the popularity of some elements of the plan obviously does not stop majorities from disliking Obamacare as a whole.

The most popular parts of Obamacare are the ones Democrats have most wanted to discuss. They are the eventual ban on insurers’ charging higher premiums to people with preexisting conditions and the reduction in out-of-pocket expenses for senior citizens buying prescription drugs. The preexisting-condition provision is central to Obamacare: To work, it requires making the purchase of insurance compulsory and subsidizing the purchase for people who cannot afford it. So Republicans cannot simply repeal all the other parts of the bill while leaving the ban in place.

The good news for opponents of Obamacare is that it will be years before these provisions are fully implemented — years during which there is no reason to expect them to overshadow the unpopularity of Obamacare as a whole — and the early steps toward implementing them will benefit relatively few voters. The better news is that Republicans can say that they favor addressing the problems of people with preexisting conditions without turning the country’s health insurance inside out. That message would be both appealing and true.

Republicans have to stop worrying about vetoes, too. Republicans who are hesitant about repealing Obamacare note that it is inconceivable that they will get the 67 Senate votes needed to override a presidential veto. The premise is correct, and it is why full repeal won’t happen until we have a new president at the earliest. But so what? If repeal becomes unpopular, Republicans won’t press it. If it stays popular, on the other hand, then a veto fight with President Obama will be helpful. (Forcing Senate Democrats to filibuster repeal legislation would be helpful, too, though less so.) Preemptively surrendering to an expected veto makes no sense; all it does is communicate fear and weakness to friend and foe alike.

The abortion issue has to be kept alive. Pro-lifers were crucial to the fight against Obamacare, not least because they had more influence among Democrats than other right-leaning groups. Government funding of abortion is also unpopular. Now the opposition to Obamacare is in danger of seeing both advantages reduced. Pro-lifers are demoralized, both because Obamacare passed and because supposedly pro-life Democrats put it over the top. And Democrats can be expected to continue to insist that Obamacare does not fund abortion at all.

Republicans can keep the anti-Obamacare coalition together by pledging to try, in the next Congress, to make the Hyde amendment, a part of each year’s government-funding legislation that bans Medicaid from financing most abortions, a permanent law that applies to Obamacare. Proposing this law, especially if most Democrats resist it, will highlight the fact that Obamacare involves such funding. It will also give pro-lifers a winnable issue to fight for. Democrats, from Obama on down, spent the last year saying that they had no interest in funding abortion in general or undoing the Hyde amendment in particular. Campaigning on a permanent Hyde amendment that applies to all government spending would put their rhetoric to a test.

Republicans can also raise the issue when Obama nominates a Supreme Court justice this summer. Does the nominee believe that Congress may restrict abortion funding? Or should judges require such funding? The legal Left takes a different view of this issue than does the public.

The early stages of Obamacare’s implementation should come to be seen as fiascoes. Events post-enactment have increased the public’s doubts about Obamacare. The announcements by corporations that Obamacare will lower their expected profits and lead to wage and benefit cuts; the revelation that the bill as drafted did not achieve what Democrats claimed for children with preexisting conditions; the dispute with veterans’ groups over the effects of Obamacare on their health programs: All of these stories have added to the public’s sense that Obamacare was poorly designed and has nasty surprises in store for them.

This summer, Obamacare is supposed to establish high-risk pools to help people with preexisting conditions — as a short-term measure until the new entitlement and regulations kick in. Republicans have advocated such high-risk pools, too, but as a way to help sick people without ruining private insurance. It is not clear that Obamacare’s risk pools will be adequately funded or well crafted. They are likely to have many more applicants than openings. Democrats will probably spin that as a sign of their popularity. Republicans need to be ready to say instead that Obamacare is already failing to deliver promised benefits.

The legislation also sends checks to some seniors this September to help cover medicinal expenses. Democrats consider this provision politically clever, but it may backfire. Seniors who do not get the checks — most of them won’t — may resent it, especially since their numbers will include seniors who purchased Medigap coverage on their own. It could come to look like a clumsy attempt to bribe voters.

The federal government will start to figure out how to disburse small-business tax credits under the legislation. These, too, could backfire, as firms announce layoffs and hiring freezes to qualify as small businesses that get the credits.

Finally, Medicare Advantage plans facing deep cuts next year will begin to notify beneficiaries this year that they will have fewer benefits or will have to find a new plan. All in all, what Democrats call the plan’s early “deliverables” could end up delivering them only pain. That they do so is not strictly necessary for repeal to succeed, but it would help a lot.

Some Democrats have to join the repeal bandwagon. The only thing bipartisan about Obamacare has been the opposition to it. The repeal campaign needs to be bipartisan, too. But Democratic politicians will come out for repeal only if Republicans put pressure on them to do so.

The first targets should be House Democrats who voted against the health-care bill. Republican challengers should come out for repeal themselves. If the incumbent Democrats fail to follow suit, the Republicans should say that those Democrats are effectively pro-Obamacare and voted No only because Speaker Nancy Pelosi let them. If the Democrat still balks, the Republican will have given himself a better shot at winning. If the Democrat succumbs to the pressure, then he will be one more vote for repeal. If this campaign gets going, it is entirely possible that the repealers will be within a few dozen votes of a majority before Election Day. Under those circumstances it will be much harder to dismiss the campaign as quixotic.

The pressure has to put the Democrats in as tight a spot as possible. Some of them will try to say that they favor repeal with various caveats. To avoid this, Republicans will need to have sponsored specific repeal legislation. (Since almost nothing in Obamacare goes into effect this year, the legislation should be a simple, one-sentence repeal. Republicans have already voted for alternatives and can continue to talk them up, but the legislation itself need not “replace” Obamacare.) The test of whether a Democrat is truly against Obamacare will then be whether he co-sponsors this legislation.

The action has to move outside Washington. It was the opposition expressed at town halls in August 2009 that stiffened Republican spines and weakened Democratic ones, thus making passage a close-run thing notwithstanding huge Democratic majorities. Washington politicians will be looking for signs that the populist anger is still there or has dissipated.

Opponents of Obamacare should therefore start as many brushfires as they can. (Metaphorically, I hasten to add, before Frank Rich realizes that cross-burnings also involve flame.) State referenda can express voters’ opposition to Obamacare. Shareholders can challenge companies’ support for the legislation. Governors can ask for relief from parts of Obamacare that impose burdens on people in their states. Gov. Mitch Daniels of Indiana has protested that the legislation threatens people with Health Savings Accounts in his state. A waiver request, with the support of several members of the state’s congressional delegation, would further publicize the issue. Other governors, whether or not they have presidential ambitions, might follow suit.

Opponents and skeptics of Obamacare cannot become resigned to it as a permanent fact of American life. This point is implicit in everything above, but it deserves emphasis. If the campaign to repeal Obamacare fizzles out, you’ll see a pattern in the polls: People who now say they are “strongly against” Obamacare and “strongly for” repeal will lose hope and move into the weak-opposition group. The weak opposition will move out of opposition altogether. Action this year — introducing repeal legislation, starting anti-Obamacare initiatives in the states, reviving the Hyde amendment, publicizing the failures of Obamacare as they occur — is important both in itself and as a way of showing that repeal is not a lost cause.

This fall, pro-Obamacare candidates must be on the defensive, and this November, anti-Obamacare candidates must be seen to have won on this issue. Republicans have to make repeal and the state of the economy their top two issues in the elections. More to the point, they have to fuse the two into their top issue, moving every argument about the economy to the long-term job-killing effects of Obamacare. They should explain, that is, that Obamacare’s taxes will make the recovery weaker and slower than it would otherwise be. For repeal to gain momentum from the elections, the exit polling needs to show, directly or indirectly, that the repeal campaign helped Republican candidates — and, for that matter, that Democrats who supported repeal helped themselves.

Republicans have to win the House. It is in Republicans’ interests to lower expectations for the November results, so whatever gains they make can be presented as earth-shattering. But there is no way around it: At this point expectations are for a big Republican year. Democrats know they are going to lose seats in the election. If Republicans merely come close to taking back the House, the Democrats will conclude that resistance to Obamacare was unable to put Republicans over the top even in a high-unemployment year. The media and some Republicans will reach that conclusion, too. And so Obamacare will get a reprieve.

Even if all these things go right for the opposition, repeal of Obamacare will hardly be assured. But that most of them will go right is very plausible. The fight over Obamacare has several more rounds to go, but Round 2 looks promising.

Ramesh Ponnuru is a senior editor for National Review. This article originally appeared in the May 3, 2010, issue of National Review.

Ramesh Ponnuru is a senior editor for National Review, a columnist for Bloomberg Opinion, a visiting fellow at the American Enterprise Institute, and a senior fellow at the National Review Institute.

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