This week, House Republicans are voting on whether to repeal the Patient Protection and Affordable Care Act. Their bill, misleadingly titled “The Repealing the Job-Killing Health Care Law Act,” has a good chance of passing the House but virtually none of passing the Senate or being signed by the President. It’s a chance for House Republicans to show the public where they stand on healthcare – but they seem reluctant to engage with the actual projected impacts of the law.
First, the jobs claim. The ACA does not kill jobs. Ezra Klein explains that what House Republicans are referring to is a Congressional Budget Office projection that the law will slightly reduce the labor supply. Basically, people who’d like to quit their jobs but can’t because they need the health insurance will soon be able to do so. Even those with pre-existing conditions (half the under-65 population, by one recent estimate) will soon be able to purchase insurance policies through insurance exchanges – so, they can retire early, spend a few years being full-time parents, or devote themselves to hatching startup ideas without worrying so much about where their coverage will come from. When some of the currently employed quit the jobs they’d been sticking with just for health insurance, I’m sure employers can find workers willing to fill those slots.
Then there are the deficit numbers.
The nonpartisan Congressional Budget Office has calculated that repealing the ACA would cost an additional $230 billion over the next ten years – hardly small change at a time when everyone’s bemoaning the deficit. Speaker of the House John Boehner claims the CBO score is wrong and the repeal wouldn’t actually increase the deficit.
While members of Congress can certainly argue over specific CBO assumptions, simply dismissing an entire score is akin to a football team that’s just lost a game saying they disagree with all the referees’ calls and declaring themselves the winner. (If you’re interested in Boehner’s specific criticisms of the score, Ezra Klein and Paul Krugman have good explanations of why they don’t actually change the $230 billion figure.)
While one aim of the law was to slow the rate of healthcare-spending growth (which plays a major role in the deficit), many reform advocates saw reducing our appalling uninsurance rate as the effort’s most important goal. The CBO estimates that repealing the ACA would leave 32 million more Americans without health insurance.
Lucky for us, House Republicans aren’t dismissing the uninsurance issue the same way they’re dismissing the deficit issue. In addition to the repeal bill, they’ve crafted a resolution instructing several House committees to propose changes that would “increase the number of insured Americans,” “provide people with pre-existing conditions access to affordable health coverage,” and do several other things that the ACA already does. (It does include a couple of things the ACA doesn’t; for instance, it requires that the changes not increase the tax burden, which the ACA does for people who choose not to purchase health insurance and aren’t exempt from the law’s individual mandate.)
If Republicans had sat down with this list of requirements three years ago, what kind of proposal for health insurance reform might they have created? I expect it would’ve had a lot of similarities with the ACA. The combination of an individual mandate and a health-insurance exchange was something Republicans championed until Democrats used it as the centerpiece of their legislation; in fact, it’s what then-Governor Mitt Romney signed into law for Massachusetts, where it’s successfully brought down uninsurance rates. Ezra Klein enumerates several ways in which the bill the Senate healthcare bill includes Republican ideas – which isn’t surprising, since Senate Finance Committee Chair Max Baucus devoted a lot of (ultimately fruitless) effort to getting Republicans on board.
Fixing a mixed-up healthcare system is much harder than obstructing and criticizing someone else’s attempts to do so.