Could Health Reform Be Repealed in 2012?

Ron Brownstein writes about the fact that since health reform would largely be implemented in 2013, the GOP presidential nominee in 2012 will likely campaign on a promise to repeal it:

Some senior House Republicans have already pledged to repeal any health care bill if they regain the majority. And many GOP challengers in 2010 will surely echo them. But with Obama holding a veto pen, Republicans probably couldn’t mount a real threat unless they won the White House in 2012. One top adviser to a possible 2012 GOP presidential contender says that, given the GOP base’s hostility to the reform plan and independents’ unease, it is likely that “most potential [Republican] candidates will argue for wholesale replacement with their own version of health care reform.”

Brendan Nyhan brings some perspective to bear on this, but I think the most important thing to note is that “health care reform” is not really one “thing” that anyone is likely to “repeal” regardless of campaign season rhetoric. The question is what, specifically, would a Republican President do. And the answer in general terms is that if health reform passes and a Republican is elected in 2012 then he (or Sarah Palin) will try to reduce taxes on high-income individuals, reduce government on the poor, increase the budget deficit, and alter regulations in a more industry-friendly manner. But of course that’s what will happen if health reform fails and a Republican is elected in 2012 also. That’s what Ronald Reagan did, that’s what George W. Bush did, and the conservative movement appears to remain every bit as committed to that strategy as it’s ever been.

Specifically, Republicans seem very likely to try to reverse the cuts in Medicare Advantage and also roll back some Obama-era tax measures. It seems unlikely to me that they would attempt to actually unravel the mandate/regulate/subsidize structure of a health insurance exchange, but they would gut or kill a public option. They would also probably want to reduce subsidy levels and handle affordability by reducing regulation of insurers leading to folks getting a lower quality of insurance. And as ever there’d be much more emphasis put on cutting taxes than on offsetting spending reductions. What actually happens, of course, depends substantially on congress. Part of the story here is that the reforms Democrats are currently pushing are extremely modest and industry-friendly as is. Republicans just really hate taxes.