Six More Reasons Why Obamacare Won't Be Repealed

The House of Representatives voted to repeal the Affordable Care Act for the 40^th time last week.  It did this before balancing the budget, passing a jobs bill, reforming election laws, or anything else that might actually improve its standing in the eyes of the general public.

So what began for some members of Congress as principled opposition to federal “overreach” has turned into a political punch line:

“How many more votes will it take for the House of Representatives to repeal Obamacare?  It doesn’t matter, because the House doesn’t count anyway.”

The very first column I wrote after the mid-term election in 2010 was entitled “Six Reasons Why Health Reform Won’t be Repealed.”  In it, I argued that there were at least five substantive reasons why the Affordable Care Act would not be repealed in spite of the Republican House takeover.  These included the popularity of the expanded Medicare benefits, the benefits to early retirees, the benefits to adult children, and the benefits to those with chronic conditions.

I concluded with a political reason.  People who were already upset at the high cost of health insurance would never vote for someone who would vote consciously to make that cost even higher.    

That is as true today as it was then.

So, almost three years later, here are six more reasons why Obamacare will remain the law of the land even after 2016, no matter how many more meaningless repeal votes the House takes between now and then, or how many Senators suggest shutting down the government to prevent its implementation.

First, states with expanded Medicaid programs will never support the repeal of that provision of Obamacare.

That means that neither will most of their members of Congress, no matter how they vote for show.  At present, those states have 205 representatives in the House.  By the end of the year, that number should be closer to 238.  In other words, by next year, states with expanded Medicaid programs will have a majority in the House of Representatives.

Second, the infrastructures to implement Obamacare in all fifty states are now being established – and one of these is an advocacy infrastructure.  Ironically, the advocacy infrastructures may become even more potent in states that have opposed Obamacare.  Because those state governments are giving them no help, they can marshal anti-government on behalf of Obamacare.  For example, the enrollment efforts of Florida CHAIN and its allies already show an impressive level of planning and sophistication.  And they will only get better in the days to come. 

It is difficult to repeal any governmental program.  It is even more difficult when there is an organized effort to protect it.

Third, the existing Medicare program for current and newly-enrolling Medicare beneficiaries is still untouchable for politicians.  

That includes the Obamacare changes that are now an integral part of Medicare – better prescription drug coverage and better wellness benefits.  Imagine being the politician who wants to take away those!

Fourth, unless and until the Congressional Budget Office changes the way it projects budget impacts, you can’t repeal Obamacare without adding to the deficit.  And, for the record, no one in office or running for office favors adding to the deficit.

Fifth, too many people – as many as 25-30 million, by most estimates – are going to benefit directly from the tax credits beginning next year.  If you repeal Obamacare and raise the annual cost of their health insurance by thousands of dollars, they will notice.  Suggesting that they can just become uninsured probably won’t cut it.  And they will probably vote against you in the next election.

And finally, the House lost the issue’s long-run political debate right after the 2012 election, when it replaced “repeal and replace” with simply “repeal.”

“Repeal” may be easier to argue in the short-term, but opponents have to have a plausible alternative to Obamacare to build their constituency.  And they don’t have one.

So whether or not Obamacare becomes more popular in the days to come, to most people it will be much better than nothing.

Even if the House casts forty more votes to repeal it, and even if more senators join the tin-eared chorus threatening to shut down the government over its implementation, Obamacare is here to stay. 

And all the members of Congress already know this.

Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/