Jonathan Chait asks if Republicans could repeal the health care bill, but I don’t think they’ll want to. The short term benefit of motivating your base by condemning a drawn out and somewhat dirty process may be substantial, but repealing policies that give billions of dollars in federal funds to the states and protect individuals from some fairly egregious insurer practices, makes little sense.
The health care reform debate may not end after the Senate passes the reconciliation package and it will certainly bleed over into the election, but the organized push to repeal reform will likely abate. For the states, the question is one of pure economics. As Emma Sandoe points out in this report, states that choose to opt out of the Medicaid expansion will lose billions of dollars in federal funding and will be no closer to grappling with the strained public health programs in their states. Note that if Idaho and Virginia (the two states that have promised to sue the government over the legislation) pull out of reform they will be denying Medicaid coverage to hundreds of thousands of constituents:
As unpopular as the bill is today, denying coverage to hundreds of thousands of residents — on the fed’s dime — can’t be a popular political position in the future. Some lawsuits may certainly advance to the courts, but they’ll be motivated a constitutional purism that doesn’t have the kind of broad based support of today’s populist outrage against the Washington process.
After the bill passes, we’ll forget about “deem and pass” and focus on the policy. As imperfect as it is, the new bill does make important investments in regulating insurers, investing in community health care centers and closing the donut hole for seniors — and those are benefits that are hard to take away. They’re a lot more tangible and significant than the insider process and special deal stories we’re hearing today. After all, Democrats were incredibly unhappy about the arm twisting that surrounded Medicare Part D, but they’re now looking for ways to improve it, not re-write it. The process fades, but the policy remains.