Don’t Count On Senate Procedure To Save The Affordable Care Act

Sarah Kliff has a wise post noting that contra Mitt Romney, the workings of the budget reconciliation process won’t really let him repeal the Affordable Care Act over the objections of a Democratic filibuster. That said, I think it’s a bit misleading to suggest that simply because 41 Republicans can halt action on all Senate business that this implies that 41 Democrats would do the same. My guess is that if the GOP wins the White House, picks up Senate seats, and holds the House of Representatives that many Democratic Senators will choose to read that as an indication of a “mandate” to repudiate the Obama administration and its signature initiatives. Maybe Joe Manchin and Mary Landrieu and Mark Warner will fight tooth-and-nail against repeal, but I kind of doubt it.

Perhaps the deeper issue is whether root-and-branch repeal is in fact a policy that a new GOP majority would pursue. They’ve said it enough times that the answer may be “yes.” But it seems to me that the actual conservative agenda just doesn’t line up squarely with total repeal. A new Republican administration would, for example, clearly pursue some major tax policy shifts. At the same time, Republicans deem the tax aspects of the Affordable Care Act to be among its most objectionable elements. So whatever tax package they pursue will presumably address that concern. Similarly, they’re committed to some major changes to Medicaid that would undue another big element of ACA. Having taken out the “tax the rich” and “in order to give medicine to the poor” elements of the law, I’m not sure how motivated they’ll be to tackle everything else when they also want to act on environmental and financial regulatory policy. It’s very easy for the out-of-office party to forget how much agenda crowding happens in practice in DC. You end up needing to decide what it is you really care about. It’s possible that the symbolic value of root-and-branch repeal will drive it to the top of the agenda, but I think it’s equally possible that the act of defeating President Obama would prove cathartic.


In general, it’s unusual for policy to literally see-saw back-and-forth with a new governing regime completely reversing the previous one’s initiatives. Even in systems like the UK’s where you have almost no veto points, policy evolves in a more nuanced way than that.