This article is more than 5 years old. Information may no longer be current.
The fate of ObamaCare: Health care legislation may face changes in upcoming elections
Click Here to Manage Email Alerts
 Douglas W. Jackson |
Many Republicans are running for office this fall on a promise to repeal the president’s health care reform — ObamaCare — and some Democrats are running on a promise to fix, but not repeal, it. To fix or repeal will depend on whether the administration loses the current support for this legislation in either the House and/or Senate following the November elections. The stage may then be set for even more changes in the 2012 elections.
Assuming the administration looses majority control over either chamber of Congress this fall, the next 2 years will bring continued showdowns in Washington in which the president may have to make the choice of using the veto or signing legislation that challenges his hallmark bill. While it is unlikely there will be enough change in Congress to override a veto, it is possible the messages received from the primaries, the 2010 election and his desire for re-election in 2012, will impact the president’s decisions and options.
Politics at its worse
Remember, there are strong feelings among the rank-and-file physicians and the public of opposition to health care reform. This is the partially the result of an administration and party that was in control of Congress pushing the health care bill through in a nonpartisan approach. In my opinion, it demonstrated another example of politics at its worst; Congressional leadership and a president who acted on what they thought was best while ignoring the will of the people.
The potential exists for a power shift following this year’s elections. If it does, this legislation will be attacked by the new Congress and special interests that will place many obstructions in the way of its implementation. I foresee several different Congressional hearings held to explain the impact this bill will have on the overall national economy and individuals — this time focusing on the real costs.
Also, I see forthcoming discussions that will include real data to demonstrate the impact the legislation will have on jobs, the rising national deficit, and new taxes and fees that will be needed to fund the legislation. Not to mention the growing resistance from the states that will persist with their legal challenges and continue to resist aspects of the federal mandates. The states are having significant trouble trying to balance their budgets and the lack of federal funding supporting this new legislation places many states’ fiscal status at further risk. The recent Florida lawsuit that was filed and joined by 20 state attorneys general, challenges if the Constitution empowers Congress with the ability to require individuals to own health insurance and fine them if they do not purchase it. Does the constitution allow Congress to impair individual liberty to this extent? It is unlikely the Supreme Court will go against Congress and limit these powers, but if it rules against this aspect of the health care reform as written, the new program will fail. Obama Care is intrinsically dependent that the risk pool and costs will be distributed over the entire population.
Paying for it
I believe we will see an increasing nationwide backlash as the public begins to fully understand the far-reaching changes that will be in place by 2014. As more data are released, the public will come to understand the extent they will be funding this new entitlement program — including the increasing funds that will be necessary for the long-term viability of Medicare — and may cause them to demand change. As more truths will be uncovered about the overall effects of the legislation on the national debt, there may be legislation introduced to attempt to limit its funding. An example could be related to the expenditures necessary for the estimated 16,500 new government agents needed to police and oversee the universal mandatory health insurance requirements, if it survives court challenges. A less-friendly Congress can challenge the long-term fiscal liability and ability to fund this program as well as delay aspects of the new tax and fee increases required in the new legislation.
The new Congress will need to oversee the many new regulations and departments that will enforce and interpret this legislation. This includes oversight and regulation of the insurance companies and what they can charge for direct medical benefits. This is already controversial and many lobbyists and special interest groups will bring much to bear in these deliberations. In addition, Donald Berwick, MD, head of the powerful Centers for Medicare & Medicaid Services may be called to testify before Congress and explain his regulatory agenda and the health care programs. He escaped explaining his approach as the White House chose to avoid a Senate confirmation by using a controversial recess appointment (see September page 3, ORTHOSuperSite.com search: 68086).
If Barack Obama’s vision for health care reform survives the changes brought by the 2010 elections, he still faces re-election in 2012. If he is not re-elected in 2012 the Congressional tactics discussed will not only challenge the legislation for revisions, but the whole program could be repealed.
Everyone agrees that health care reform in this country is necessary and something meaningful needs to be done. Whatever the eventual program entails is must have real cost controls and should not sacrifice quality. The question the next two election cycles will address is: can the current health care expansion legislation be fixed and improved in our current political system or will it take starting over?
- Douglas W. Jackson, MD, is Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; e-mail: OT@slackinc.com.
