The Politics of Repealing Health-Care Reform

Last night, many Republicans privately think they were handed a gift: a bloody piece of prime rib to stoke unrest in their base. Between now and November, conservatives will grouse shrilly about the coming evil of reform. We'll hear how it will ruin the country, and bring forth the dreaded socialization of our hospitals and care providers. Medicare will be cut, the elderly uncared for. Premiums will skyrocket. But as far as Democrats are concerned, that's OK. Why? Because now that health care has passed, Democrats have a chance to expose the lies. Before, it was straw man against straw man, Republican claims against Democrats'. Now, it's straw man against lived reality. Democrats finally have a chance to prove half truths and misleading claims wrong, not just argue that they are and point to a giant stack of paper as evidence.

Just a few hours after the House passed historic health-care-reform legislation, Sen. John McCain vowed, on Good Morning America, that he'd fight to repeal the bill. Others are plotting legal challenges over the constitutionality of the individual mandate, a battle the White House is reportedly well armed for. Conservatives have been hinting at a campaign to repeal the newly passed bill for weeks. But actually having to run one is their worst nightmare. They never wanted to get to this point. They know that repealing the legislation will be far more difficult than passing it was, and by now, Americans fully realize how arduous the journey to last night was. At this point, repeal is fantasy.

For starters, Republicans simply don't have the numbers in either chamber. It's doubtful that even Democrats who voted with them last night, would support a repeal of their president's signature achievement. Pelosi may have allowed a few members in difficult districts to sit this one out, but she certainly wouldn't allow them to actively undermine her. Moreover, Republicans are far short of the requisite 60 votes in the Senate. And besides, its become abundantly clear over the past year that having the votes in the Senate is a very different proposition than having the party unity to exercise them.

More significant though is the political difficulty of arguing against the benefits of the bill, especially the ones that kick in early. Republicans will have to tell people with preexisting conditions that their new ability to access coverage will be withdrawn. They'll have to tell young people and their parents that young folks won't be able to stay on the family plan. They'll have to tell Americans that they're fighting to allow insurance companies to drop sick people from their rolls once more. Those aren't easy fights to have. Health-care reform was much easier to dog before it actually becomes law.

Of course Republicans can argue that they'd repeal the package but reinstate certain popular provisions, but Democrats have two easy rejoinders. First, the country can't afford to force insurers to keep people on their rolls without also expanding the entire pool of insured people. And without the cost-cutting measures, the bill is just a spending bill. Second, after years of controlling Congress and not acting on health care, Republican's don't have a lot of credibility on the issue.

Now reform has passed, Democrats look to have the messaging on their side. Obama's former campaign organization, Organizing for America, will be joined by labor unions and the AARP in a rigorous campaign to promote the benefits of the bill, particularly those that take effect immediately, like the ban on exempting a child's preexisting condition from coverage. They'll be bolstered new media-driven narrative about the president, one where he's scored a massive, history-making victory, cementing his vision and granting his presidency new momentum. The struggling presidency is soon to be become the accomplished one.

Lastly, once Americans start receiving benefits, they don't like giving them up. Take Medicare Part D, the expensive prescription-drug benefit that has cost the country billions. Although it was fiscally irresponsible, it won't be repealed, and anyone running on revoking that benefit would likely lose. The same thing will ultimately apply to the beneficiaries of reform: the underinsured, self-employed, young people and those with chronic conditions. They're not going to give up what they just won without a fight. Although many of the benefits won't kick in for several years, the fact that the dire predictions of Republicans won't come true either will surely sate many voters. After all, if Republicans are right that many Americans like the current system, most people aren't going to see significant changes before November. It's hard to make independent voters angry over some terrifying costs when their health-care bills haven't changed.

James Fallows at writes "The significance of the vote is moving the United States FROM a system in which people can assume they will have health coverage IF they are old enough (Medicare), poor enough (Medicaid), fortunate enough (working for an employer that offers coverage, or able themselves to bear expenses), or in some other way specially positioned (veterans; elected officials) TOWARD a system in which people can assume they will have health-care coverage. Period." That mental shift toward a collective mindset where health-care access is a given is critical to the success of health care. It's slowly happening, and it's the reason why the notion of repealing the bill is folly.