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Summary: House Republican leaders unveiled a "Pledge to America" yesterday to repeal the health care overhaul law, along with other promises like canceling the unspent stimulus money. The New York Times asked me to write a short Op-ed for “Room for Debate.” The question at hand: “Can the Republicans gain traction on a promise to roll back benefits that are now in place? Conventional political wisdom says you can't sell a negative. But in what situations has such an approach won voter support?” You’ll find my piece, along with opinions from three other contributors, here.  

Below, the original version of my piece, restoring some information I cut to fit the Room for Debate format. You can Enter the Discussion on the Times site, and/or comment here.

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Even Sen. Tom Coburn (R-Okla.), who signed the pledge to “Defund” the Accountable Care Act (ACA) confesses: “There is only a certain limited amount of things you can do” to undo reform. “You can get a vote to repeal it, and the first thing [Obama] will do is veto it. That is an exercise in futility. What you have to do is go to the specific areas where money is spent to implement it and put a limitation on the expenditures.”


Easy to say; hard to do. “I wouldn’t dismiss it, but I would be surprised if it actually happened,” Gail Wilensky, an economist and senior fellow at project HOPE,  recently told Politico.com reporter Carrie Budoff Brown. “You hear this periodically when there are core groups that don’t like something. ... It is easy to talk about rhetorically; it seems to have been very hard to pull off.”


And Wilensky, who directed Medicare and Medicaid from 1990-1992, and served as Deputy Assistant to President (GHW) Bush for Policy Development, from 1992-1993, has been around Washington long enough to know what is and isn’t doable.

Consider the precedents: Medicare, Social Security and the Civil Rights Act all met fierce opposition, even after they were passed. Yet over time, the legislation was accepted and expanded. Conservatives are fond of pointing to the Medicare Catastrophic Care Act (MCCA), which was overturned shortly after it was passed in 1988. But this was because seniors alone were asked to carry the full burden of funding through higher premiums and an income tax surcharge. (Former Congressman Dan Rostenkowski --once the chairman of the US House Ways & Means Committee-- would never forget the angry mob of seniors who chased him down the street and then swarmed his car, like hornets.)  Those grey panthers were extremely well organized and focused on a single issue. Those who oppose the ACA are not. 

Unlike the MCCA, the Affordable Care Act (ACA) spreads costs,  raising fees for insurers, drug-makers and device-makers, cutting overpayments to Medicare Advantage insurers, and raising taxes only for the top 2 percent (individuals earning over $200, 000 or couples earning over $250, 000).  The ACA stipulates that Medicare co-pays and premiums cannot be raised. 

Meanwhile, today, popular provisions of the ACA begin to kick in, including requirements that insurance companies offer coverage for dependents under 26 ---and for children under 19 suffering from pre-existing conditions. Once you roll out social programs, it’s difficult to take them back.

Republicans vow that they’ll “defund” reform.  But, while some programs require discretionary funds from Congress, many major provisions are funded with mandatory spending.  Medicaid expansion might seem vulnerable; the poor have few lobbyists. But any change in the Medicaid provision would require separate, free-standing legislation. Conservatives can’t take back the funding simply by making routine changes during the appropriations process. Finally, if opponents killed the bill, they would have to find a way to pay for the estimated $143 billion reduction in federal deficits created by the law.

Some call for repealing the least popular plank in the ACA—the individual mandate.  But the mandate supports the most popular provision—which says that insurers cannot discriminate against those suffering from pre-existing conditions. Without the mandate, many would simply wait until they were sick before signing up for insurance, safe in the knowledge that insures must take them and can’t charge them more. And if healthy customers stayed out of the insurance pool until they fell ill, premiums would sky-rocket.

Read More: http://www.healthbeatblog.com/2010/09/roll-back-reform-easy-to-say-hard-to-do.html