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If Romney wins, can he kill PPACA?
June 29, 2012 11:10 AM   Subscribe

Can someone explain to me how November's Presidential Election in the USA would impact the Patient Protection and Affordable Care Act?

Bob is an acquaintance of mine and he seems convinced that everyone's poopooing over the Supreme Court's ruling yesterday isn't going to matter because Romney is going to win the election and.. totally kill PPACA with a sharp pen and a signature.. I assume.

Now, I think he's misinformed, but I am not an informed individual myself. If Romney wins, can he do anything about PPACA?

I know our President can't make laws and at best he can encourage Congress to write a bill. All he really has is a say in the end whether he signs it or not. If the current congress supports PPACA (Does it?) can a new President really swoop in and change their minds?

Or is this a case of the current Congress really not liking PPACA but can't do anything about it because they know the current President would veto anything they try to do?

If someone could help clear this up for me, I'd appreciate it. I'm one of those people that PPACA would help.. but I don't want to get my hopes up in case November brings with it the death knell of the act.
posted by royalsong to Law & Government (17 answers total) 1 user marked this as a favorite
 
It is very unlikely that President Romney happens without that same election leading to a Republican House and a Republican or very narrowly split Senate. It's very reasonable that in those conditions, a law could be passed that would repeal, cripple, or simply defund the ACA.

The barrier to this is not really Congress per se so much as the popularity of specific parts of the ACA - ie, it's one thing to say "Repeal the ACA," which is popular, but another to say "Bring back denial of health care to people with pre-existing conditions," which is not popular.
posted by Tomorrowful at 11:16 AM on June 29, 2012


It's very reasonable that in those conditions, a law could be passed that would repeal, cripple, or simply defund the ACA.

The GOP would also need to have 60 votes in the Senate to overcome a DNC filibuster of a repeal bill. What they could do if they win a majority is gut the funding and cripple the bill.
posted by The 10th Regiment of Foot at 11:42 AM on June 29, 2012


Or is this a case of the current Congress really not liking PPACA but can't do anything about it because they know the current President would veto anything they try to do?

The presumed future Congress. If Romney wins, presumably the GOP retains the House (which has been holding meaningless "repeal" votes for the past 18 months) and takes the Senate majority (the Dems are defending swing seats that they took in 2006, which makes it difficult to retain control, and who knows what happens to the filibuster?) and that creates the conditions for a straight repeal that the president signs.

The barrier to this is not really Congress per se so much as the popularity of specific parts of the ACA

All polling suggests that the public is less enthusiastic about the ACA/Obamacare as a concept than its component parts, which makes "full repeal" politically saleable. What this says about American politics is left as an exercise to the reader.
posted by holgate at 11:42 AM on June 29, 2012


Multiple large health insurance providers have already put many of the required changes into motion, and it would be expensive and foolish for them to undo those changes next year. At the very least, both Aetna and UHC have admitted that they won't change their policies either way - you'll still be able to keep children on until 26, there won't be the "pre-existing condition" denials of coverage, and there won't be anymore retroactive policy rescissions against expensively ill patients.

So, yes, the law can be repealed if the congressional election breaks exceedingly well for the republicans. But, some of the good things it brought about are essenetnially stuck in place, at least for the moment.
posted by Citrus at 11:52 AM on June 29, 2012


These 2 articles might help you:

http://www.thedailybeast.com/articles/2012/06/28/repeal-is-a-fantasy.html

http://www.newyorker.com/online/blogs/newsdesk/2012/06/why-romney-wont-repeal-obamacare.html#ixzz1zCIy8dbv
posted by dealing away at 12:00 PM on June 29, 2012 [1 favorite]


As others have said, in order for Romney to repeal it on day one of his presidency, he'd need to get it through the Senate and need to get 60 votes to do so. You could do it through reconcillation and only defund, which makes it a 51 vote threshold plus getting all of the weird Senate parliamentarian t's crossed and i's dotted, which, despite the Republican party's recent unity, would be really crazy to pull off.

I think the more likely way for it to be "repealed" under Romney would be through the state waivers -- in which state's set up their own insurance plans which are different than the federal guidelines (but still meet some goals set up in the plan) and then can opt out of some provisions of ACA.

I think the waivers are a great idea in theory (because they allow for greater competition) but they could be used to entirely collapse the whole thing (because if enough states opt out, it makes it harder to keep funding)

While I think that's more likely*, once you get to that point, you have people at the individual state level saying "we're giving you this which is less than that which you already have", which, as others have pointed out gets harder to do (though we only have to look at Scott Walker in Wisconsin to see how you can have success at doing very unpopular things if you have enough money behind you)

The difference in this case is the money. While there are tons of people who want ACA to fail for political reasons, there are also a lot of corporations (and doctors and eventually patients) who will benefit from it. While it was easy to lobby against single payer, it becomes a lot less easy to lobby when there are companies who don't want to lose the money they think they are going to get (from the government and from new customers)
...or what Citrus just said.

And eventually, I think people will start to come around on ACA, now that the Supreme Court has let it stick around. Insurers are set to refund $1.1 billion dollars to employers and individuals this summer in order to meet the requirement that they spend at least 80 percent of premiums on medical care or quality improvements, and now ACA isn't being overturned, those payments have to be made by August 1. Though a lot of that ($700 million) is going to employers with group coverage, that still leaves $400,000,000 is going to individuals, and I don't think the importance of that (and how it relates to yesterday's decision) should be overlooked.
posted by MCMikeNamara at 12:01 PM on June 29, 2012


Ryan Lizza doesn't think Romney could get a full repeal through the reconciliation process. Matt Yglesias and Ezra Klein disagree.
posted by General Malaise at 12:13 PM on June 29, 2012


The Yglesias article General Malaise links represents my position, too. There is no way that a Republican House, Senate, and President are going to let the filibuster stand in the way of repealing the PPACA. They'll either pass it through reconciliation or say that the threat to the Republic is so grave that we must get ride of the filibuster to save our country. I have very little doubt that they would find a way to end this law if they have even 50 Senators.
posted by Alexander Hatchell at 12:24 PM on June 29, 2012


What you can enact with 51 votes you can repeal that way, and some of the elements which passed with 60 might be able to be repealed with 51 given the Supreme Court's re-characterization of the mandate as a tax.

A year ago I would have been skeptical that you could use Presidential waivers to frustrate the law, but Obama is making big precedents around the aggressive use of executive power in contradiction to legislative intent (not defending DOMA in court, exempting large swaths of illegal aliens from enforcement of the immigration laws, etc.) A 50-state waiver seems a lot more realistic now.

I do tend to agree with MCMike that people tend to forget that the litigation against Obamacare was a partisan and ideological matter. Interest groups lobbied hard for and got broadly protective, or even beneficial, provisions into the law, and no few of them might be there to argue to protect the law or favored provisions thereof.
posted by MattD at 12:26 PM on June 29, 2012


So.. prospects are bleak..?
posted by royalsong at 12:29 PM on June 29, 2012


It's pretty simple. If Obama wins, his veto protects the ACA. If Romney wins, there is nothing, not even a filibuster, that prevents a Republican Congress from repealing the ACA.
posted by JackFlash at 12:36 PM on June 29, 2012


The GOP would also need to have 60 votes in the Senate to overcome a DNC filibuster of a repeal bill. What they could do if they win a majority is gut the funding and cripple the bill.


Yes and no. The "Health Care Bill" that everyone talks about is the Patient Protection and Affordable Care Act of 2010 which required a filibuster-proof majority, passing 60-39.

Remember that a significant portion of the reforms passed through the Health Care and Education Reconciliation Act of 2010, which was a budget reconciliation bill. Budget reconciliation needs only 51 votes in the Senate and cannot be filibustered, but applies only to a specific set of revenue and appropriations matters. If Republicans pick up the Senate, they will gut as much of the reforms as they can through reconciliation. While they cannot remove all of the bill through reconciliation, they can certainly gut it to the point where the other provisions become quite useless.

Remember that a Romney victory would install a Republican tiebreaking vote in the form of the Vice Presidency, so killing the bill through reconciliation requires only 50 Republican Senators. In my view, Romney victory coupled with Democrats retaining the Senate is quite unlikely. Vulnerable swing-state Democrats would be hard-pressed to fight the wave. They might not even need 50 Republicans, conservative Democrats like Joe Manchin would be vulnerable to cast an apostate vote.
posted by Hollywood Upstairs Medical College at 12:37 PM on June 29, 2012 [1 favorite]


Specifically, I'm thinking of the ban on recission and lifetime coverage limits, which doesn't seem on its face to be a budget issue but passed through the reconciliation bill.
posted by Hollywood Upstairs Medical College at 12:42 PM on June 29, 2012


Prospects for the law aren't bleak, at least in the short-term.

It's more likely than not that the Republicans won't get the requisite sweep, and even with such a sweep some or all of the law could survive.

Even if effective repeal of Obamacare doesn't need 60 votes in the Senate, many things do, and Democrats would be highly incentived to trade away some filibusters to save some of the law, and lobbyists would surely be looking to peel away a vote or two.
posted by MattD at 12:44 PM on June 29, 2012


Just one comment about public opinion, mentioned above. If a pollster called me and asked if I approved on the Affordable Care Act, I would say no. However, the reason I would say no is because I do not believe it goes nearly far enough toward universal health care for all. I think the very high negative ratings for ACA include a significant number of people like me. I don't want ACA repealed, I want it expanded.
posted by hworth at 12:50 PM on June 29, 2012 [3 favorites]


The version of PPACA that made it through Congress is not the one that was proposed by President Obama. It was modified heavily in Congress until they got to something they could almost agree to agree on. There is a strong opposition stamp on this legislation the way it is.

Mr. Romney has very little to gain by acting to repeal PPACA, and a lot to lose. Chief Justice Roberts knew that a negative ruling by SCOTUS would effectively cost Republicans the next election. I'm sure Mr. Romney doesn't want to be a lame duck after only two years in office.

I'm pretty surprised at the level of energy he is expending in his campaign on this issue. It seems like it would have been better to let it quietly fade from the news cycle.
posted by halfbuckaroo at 8:22 AM on June 30, 2012


The GOP would also need to have 60 votes in the Senate to overcome a DNC filibuster of a repeal bill.

Except that when the GOP sets the new rules of the Senate (assuming they win control) they can get rid of / modify the filibuster. So they'll just need the 50 votes, with the vice president breaking the tie if need be.
posted by mikepop at 6:58 AM on July 2, 2012


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