Wednesday, November 10, 2010
For Democrats in 2010, healthcare reform proved to be an achievement of lethal political magnitude. Rather than voters learning to love it over time, opposition to the historic law has only intensified since its enactment and contributed to an historic shift of power in the House and losses in the Senate. Whether the opposition toward the law is, at its heart, a public relations problem as Democrats claim, or a policy problem as Republicans argue, proposed changes to the law next year – including an operationally symbolic vote for repeal in both chambers – will be discussed, debated, and demagogued. In short, the Washington communications channel titled "Healthcare Reform" will remain open and active.
The specter of Congress reopening the healthcare reform law presents as many challenges (and potential landmines) as were created by the debate around the original law. At that time, there was reluctance among the vast majority of healthcare stakeholders to appear anything but supportive and constructive in passing healthcare reform. Now, the calculation could get trickier for individual companies. Those with interests at stake will need to walk a fine line between collaborating with the Democratic regulators making critical decisions about reform implementation, and gaining favor with the Republican-controlled House that will shape the broader healthcare legislative landscape.
With Republicans promising repeal without the means to accomplish it, the fight next year will likely move to repealing sections of the law, such as the controversial individual mandate. When that presumably fails, Congress will move to defund and underfund enforcement and implementation of the law by cutting off and reducing appropriated funds for the executive branch; control of the purse is a powerful tool that lawmakers uniquely hold over the president. Indeed, of the reform bill, Chairman of the Republican Governor's Association Haley Barbour boasted recently: "They [Republicans] will make such big changes to it over the next three years that you won't recognize it." In addition, at some point, the president will not be able to veto his way out of the deleterious efforts to weaken the law, and the Republicans may find enough votes in both chambers to repeal the most unpopular and, in some cases, tangential pieces of the law, such as the IRS paperwork requirements on small businesses inserted as a revenue-raising provision to help offset the costs of the new law.
The full impact of the law will be determined largely through the regulatory process, and companies will need to work with HHS and its various departments newly established as a result of healthcare reform in ways never before seen. While the next Congress is unlikely to pass any major healthcare legislation, the impact of reform will reverberate well into the 2012 elections.