What To Expect From ‘Repeal And Replace’ Efforts

Kaiser Family Foundation poll (PDF) asks people about different aspects of the Affordable Care Act:

This gives us a good guide to what’s likely to happen if Republicans win the 2012 election. My read of how these things work is that the views of the mass public will be irrelevant, since swing voters don’t know anything about the content of legislative proposals. Instead, Republican elected officials will be driven by a mix of their own convictions, interest group politics, and opinion among Republican voters. That strongly suggests that the Perry administration will reduce taxes on high-income individuals and pay for it by denying subsidized health insurance to poor people. The Medicare “doughnut hole” provisions should survive, since neither the GOP base nor the pharmaceutical industry wants to scrap this and the Republican plan to scrap Medicare entirely for people under the age of 50 makes it moot in terms of the party’s long-term objectives.

The interesting issue here is the dynamic around pre-existing conditions and the mandate. The mandate is super-unpopular among Republican voters, and it’s unpopular enough among Democratic voters that it seems unlikely that Democrats would even fight hard to keep it. The sticky wicket here is that the pre-existing conditions regulations are super-popular, even with Republicans. And the insurance industry isn’t going to like the idea of repealing the one without the other, and doing so would create awkward problems in the medium-term. My guess is that Mitt Romney, who has considerably more subject matter knowledge on this front than his rivals, basically understands this, and that’s why he’s touting promiscuous waivers as his key policy lever.