The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Posts Tagged ‘Republicans’

Moving Beyond Health Care Reform Repeal to Revision

Posted by Alan on January 27, 2011

During the 2010 election Republicans promised to “Repeal and Replace” the Patient Protection and Affordable Care Act. Having gained a majority in the House of Representatives they quickly passed a bill to do just that (joined by three Democrats). Having failed to gain a majority in the Senate the repeal process is all but over.

Senate Majority Leader Harry Reid has said he would not bring the “Repealing the Job-Killing Health Care Law Act”to the Senate floor for a vote. In response Republican Senators have promised to offer amendments repealing what they see as unpopular provisions of the law. In both the House and Senate GOP lawmakers are targeting the PPACA’s requirement that all Americans obtain health insurance coverage, malpractice reform, taxes imposed on health insurance carriers and others, denying federal subsidies (including tax deductions) for health plans that cover abortions, and permit the sale of health insurance across state lines. While Republicans know these amendments will fail, forcing Democrats up for election in 2012 to cast several votes defending President Barack Obama’s health care legislation has significant potential political benefits.

But two can play this game. So if Republicans force a vote on their measures, Democrats will require GOP Senators to vote on legislation concerning more popular elements of the PPACA. These include closing the Medicare prescription benefit donut hole, eliminating pre-existing condition exclusions for children, and allowing children to remain on their parent’s health plan up to age 26.

Then there’s the coming Republican effort to defund the PPACA. (Which creates an enjoyably ironic situation. Many in both parties, but especially Republicans, argued Democrats were arrogant to pass health care reform in the face of polls showing the public opposed their legislation. How will they respond to a Kaiser Family Foundation and Harvard School of Public Health showing 62 percent of respondents opposed cutting off funds needed to implement the PPACA?)

What all this means is that we’re in for two years of political showmanship concerning health care reform. But that doesn’t mean meaningful changes to PPACA won’t be forthcoming. President Obama declared his willingness to sign a medical malpractice reform bill. Of course there’s tort reform and then there’s tort reform. Health and Human Services Secretary Kathleen Sebelius has committed to providing “what the parameters of medical malpractice reform might be” during a hearing of the Senate Health, Education, Labor and Pensions Committee Hearing. Whether there is enough common grounds with GOP proposals to deal with medical malpractice remains uncertain until then. Meanwhile, 60 Senators have signed onto a bill to repeal the the 1099 reporting provisions contained in the health care reform law. Down the road there will be efforts to gain bi-partisan support for changes to more difficult provisions of the new reform law, including medical loss ratio requirements and the exchanges.

Yes we’ll all be subjected to the sound and fury signifying only political posturing and one-upmanship. But there will also be acts of quiet negotiation aimed at what President Obama in his State of the Union speech called “improving” the Patient Protection and Affordable Care Act. And as Politico Post describes the reaction of this language by Julie Barnes, director of health policy at the Bipartisan Policy Center, this could well be “a signal that bipartisan cooperation on health reform tweaks is on the horizon.”

One can only hope.


Posted in Barack Obama, Health Care Reform, Healthcare Reform, Patient Protection and Affordable Care Act, Politics, PPACA | Tagged: , , , , | 3 Comments »

Health Care Still Vital Issue in 2008 Campaign

Posted by Alan on March 9, 2008

The Kaiser Family Foundation has been issuing quarterly tracking polls on the issues voters want presidential candidates to address. Health care has been the top domestic issue voters are focused on (Iraq has been the top issue). But now that the mortgage crisis, gas prices and a faltering stock market has had more time to impact family’s sense of financial security, the economy has taken on greater importance to voters.

In the March 2008 Kaiser Health Tracking Poll 45 percent of the voters listed the economy as one of the two issues they would most like to hear presidential candidates talk about. 32 percent of the voters listed Iraq and 28 percent mentioned health care. Immigration followed with 14 percent, education with seven percent and terrorism six percent.

The economy topped the list for Democrats, Republicans and Independents alike. For Democrats, however, health care was the second most mentioned issue followed by Iraq.

In the Kaiser poll published in December 2007, Iraq was the top issue, mentioned by 35 percent of those surveyed, followed by health care mentioned by 30 percent and then the economy, cited by 21 percent of the participants. Democrats, Republicans and Independents all ranked the top three issue in this order.

When asked what single issue will most drive their choice for the next president, the economy was at the top of the list for all voters, Democrats, Republicans and Independents. For Democrats and Independents, the next two issues were Iraq and health care; for GOP voters it was terrorism and Iraq.

In March, the top issue for all voters was Iraq, followed by the economy and health care for Republicans and Independents, while Democrats selected health care and the economy as their next two most important issues.

While the economy has supplanted health care as the top domestic issue among voters, health care is still a powerful issue. However, health care costs are a factor in how people feel about the economy. 10 percent of voters cited health care costs as the single most important economic issue facing you and your family. This trailed inflation (26 percent), high taxes (13 percent), and the price of gasoline (11 percent), but it was higher than items like problems getting a good-paying job or a raise in pay (nine percent) and the cost of housing (six percent).

Health care reform remains a critical issue, especially among Democrats and Independents. When evaluating health care reform proposals, 58 percent of what the Kaiser Foundation calls “health-focused voters” want to provide health insurance for nearly all of the uninsured, even if it involves a substantial increase in spending. 30 percent support a more limited plan that would cover only some of the uninsured, but involve less spending.

In 1992, the sign in the Clinton campaign war room read “It’s the economy, stupid.” What’s less well known is the addendum to the sign that read, “And it’s health care, too.” History looks like it’s repeating itself (although this time it may not be a Clinton war room). While Iraq will remain a critical issue, the economy and health care are even more relevant to voters’ decisions. That could change, but barring a terrorist attack on American soil, the voters are increasingly focused on the economy and remain strongly interested in the candidate’s positions on health care.

In other words, future debates will sound a lot like the recent debates. 

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , , , , , , , | 1 Comment »

Republicans Sidelined By Choice?

Posted by Alan on October 5, 2007

The San Jose Mercury News had an interesting editorial yesterday which took to task the Governor and the Legislature on their failure to deliver on health care reform “two weeks into Gov. Arnold Schwarzenegger’s special session of the Legislature.” Some of what they had to say strikes me as greatly unfair. Lawmakers are seeking public input on proposals. If that takes some time so be it. Better the public should be heard than not, a sentiment I’m sure the Mercury News would agree with.

It was editorial’s criticism of Republican Legislators that got me thinking, however. As the Mercury News observes, the likely output of the special session, if there is any, will be legislation creating the framework for a new heatlh care system tied to a November 2008 initiative to finance and implement the reforms. The reason is that without Republican votes, there is no way the Governor and the Democratic Leadership can gain the two-thirds vote necessary to pass a spending bill.  Yes, as the Mercury News notes, “… instead of taking advantage of a prime opportunity to negotiate from strength, Republicans are remaining on the sidelines ….”

And he’s right. Republican legislators have been scarcely heard from on health care reform of late. There have been some op-ed pieces published in newspapers around the state (many of them quite good), but they’re clearly not a part of the negotiations. Earlier in the year the Republican caucuses presented their reform packages. Several of their ideas were innovative and would definitely improve the lives of many Californians, which is, after all, the goal here. The Democrats never held hearings on those bills and now the Republicans are “on the sidelines.”

Which makes me wonder: why? Is it their choice to leave the room or were they escorted out? (This being a Democratic leadership who punishes moderates in their own caucus by locking them out of their offices for crime of daring to be, well, moderate, perhaps “kicked” would be the more appropriate verb than “escorted.”). In a strange way it’s a bit of both. Republicans are so locked into a “no new taxes” mindset that they tie their hands on public policy. Since the Democrats are looking at expensive changes, why should they tolerate anyone at the table who can’t support the results under any circumstance? As a result, the only folks around to negotiate a compromise are the Democratic Legislative Leadership and the post-partisan Governor — or at least their staffs. The Republicans are no where near, without any influence.

Could they have a voice in the reform debate? It depends, I suppose, on how pure they want — or need — to be. If no new revenue sources are acceptable then I guess there’s nothing more for them to say. But maybe if they held out the possibility that if the health care reform package was a net win for the state’s economy and financial well-being (far from a sure thing, but definitely possible) that they could support it, perhaps their voice would be part of the debate. And that would be a good thing. Every voice needs to be heard, conservatives as well as liberals (and post-partisans, too). 

For example, when I was on the Santa Monica City Council there were two factions — the liberals and the moderates (this being Santa Monica even the conservatives were moderate) — with three members each (and they were formal members of their factions, running as slates and all). The seventh member was me who was independent of both coalitions. The best success I had was when I used my influence as a swing vote to force the two sides to reach a compromise. The result wasn’t necessarily what I would have come up with on my own, but it was something a broad spectrum of the city could get behind.

The same dynamic could happen with health care reform. It is a shame, however, that Republican have backed themselves so deeply into a no-tax corner that they deny themselves — and the people of California — the benefit of their ideas, influence and participation.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics | Tagged: , , | 1 Comment »