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The Health Care Congress

Jan 31, 2011, Vol. 16, No. 19 • By MATTHEW CONTINETTI
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Something remarkable happened in Washington last week, and too few people in the media and politics appreciate it. The House of Representatives voted to repeal the Patient Protection and Affordable Care Act of 2010 less than a year after Congress passed it into law. What’s more, the vote for repeal (245-189) was larger than the vote for passage (219-212). We racked our brains trying to figure out the last time a major piece of legislation was repudiated by a chamber of Congress with such speed and decisiveness. The answer is 1989, when Congress repealed the Medicare Catastrophic Coverage Act it had passed 17 months before, and President George H.W. Bush signed the repeal.

The Health Care Congress

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That won’t happen this year. But Republicans can’t buy into the narrative that the vote for repeal was merely “symbolic.” It was anything but. Not only did the vote for repeal demonstrate how far the pendulum has swung, it’s also part of a larger campaign against the health care law that’s taking place at both the federal and state levels. As the House voted for repeal, six additional states joined Florida’s lawsuit challenging Obamacare’s constitutionality, bringing the total number of plaintiff states to 26. And that number doesn’t include Virginia, where Attorney General Ken Cuccinelli has brought a separate suit.

Let’s review some recent political history. In the two years since Obamacare appeared on the horizon, the Tea Party has become a major force in American politics. Republicans have won governor’s races in Virginia and New Jersey, a U.S. Senate seat in Massachusetts, and had their best results in congressional elections since 1946.

Now, one chamber of Congress has voted for repeal, more than half the states are challenging the constitutionality of Obamacare’s individual health insurance mandate, and the law remains unpopular. Health care spending and premiums continue to rise, and the president’s claim that the law allows you to keep your health plan has been proven false. Can somebody remind us why the law’s supporters continue to think they have the winning hand?

The truth is that if Republicans in the 112th Congress spent the next two years doing nothing but debating the health care law, beginning to dismantle it, and offering alternatives, they would have real momentum heading into the 2012 election.

The Affordable Care Act is one giant weight on President Obama’s back, and he can’t shake it off. When it comes to federal spending, regulation, and pro-business rhetoric, Obama has the freedom to move to the center. He can call for spending reductions, order a regulatory review, promote American exports, give speeches before the Chamber of Commerce, and powwow with CEOs. He can install Clintonites in important positions and listen to his inner Dick Morris. Indeed, he’s already doing all these things.

What the president can’t do is shirk responsibility for a mess of a law that was passed without public support. Which is why Republicans in Congress have a huge opportunity in front of them. They are in a position to force the president constantly to defend the worst aspects of Obama-care. They are in a position to force him to sign bills repealing parts of the Affordable Care Act, such as the provision requiring small businesses to file 1099s whenever they spend more than $600 with a particular vendor.

Obama has already conceded that the central accomplishment of his presidency could be “improved.” Signing legislation that removes components from the law, or introduces free-market mechanisms and tort reform into the pre- and post-Obamacare health system, would further weaken the president’s position. Every signature would be a reminder that President Obama was wrong in 2009-2010. Every fight would send a message to voters that liberal Democrats do not have a monopoly on health care policy. John Boehner will be remembered as speaker of the health care Congress.

As the fight goes on, though, it’s important that Republicans don’t get bogged down in budgetary nitty-gritty. The public has a tendency to tune out the conversation whenever it hears the letters “CBO.” The fact is that no one actually knows how much Obamacare will cost, for the simple reason that no one knows how many people will join—or be forced to join—the subsidized health insurance exchanges. Chances are, of course, that many more people will sign up for subsidies than the bookkeepers expect. That would balloon the cost of the program and wreck the budget. The way to prevent that from happening is repeal.

How to get there? Focus on what drives opposition to the Affordable Care Act: resistance to federal control. The voters who went to town hall meetings and joined Tea Parties and voted Republican in 2010 do not like the idea of the federal government interfering with their health care arrangements. They don’t want to see Medicare cut to pay for a new entitlement. They believe that taxes and regulations originating inside the Beltway hurt the economy and limit individual freedom. They do not want decisions about health care cost and availability to be determined by Kathleen Sebelius and the Department of Health and Human Services. The idea that the federal government could force someone to buy health insurance repulses them.

Attack Obamacare’s taxes and mandates, and Democrats will have to play defense. Offer the public common-sense measures to introduce competition and portability into the health insurance market, and Republicans will reap the political rewards. Let the debate rage over who knows better—the people or Washington, D.C.—and the people will win every time.

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