After a year of debate over health care, many elected officials aren’t done yet. Over the congressional recess, Democrats are singing the praises of the new legislation while Republicans continue to blast away at the less popular provisions.
From a fiscal perspective, the danger of this rhetorical battle is that it may obscure the critical need for trade-offs between new benefits and new obligations. The Republicans’ “repeal and replace” slogan takes aim at politically vulnerable aspects of the health care bill such as Medicare cuts, tax increases and mandates. Republicans are equally clear, however, that they do not want to get rid of crowd-pleasing provisions in the law such as the prohibition against insurance companies refusing coverage based on pre-existing conditions.
Even before the legislation was signed, some influential House Democrats were hinting that certain unpopular parts of the plan could eventually be tossed overboard. Particularly vulnerable in this regard is the tax on high-cost insurance plans, which was pushed off until 2018 due to opposition by many House Democrats and labor unions.
It is little wonder then that many “deficit hawks” are expressing concerns that the advertised deficit reduction in the bill may not stand the test of time, or political pressure.
As Concord Coalition Executive Director Bob Bixby points out in a recent blog post, the hard parts of the legislation are necessary to making the popular elements work in a fiscally responsible manner. He says, “the surest way to guarantee exploding deficits would be to leave in place all of the popular insurance reforms and repeal the politically difficult choices that have been made to pay for them.”
In short, we can’t expect something for nothing in revamping the health care system.